[Microsurgical vascular decompression for hemifacial spasm. Follow-up over one year, clinical results and prognostic factors. Study of a series of 100 cases].

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  • Additional Information
    • Transliterated Title:
      Décompression vasculaire microchirurgicale pour spasme hémifacial. Résultats cliniques à plus d'un an et facteurs pronostiques. Etudes d'une série de 100 cas.
    • Source:
      Publisher: Masson Country of Publication: France NLM ID: 0401057 Publication Model: Print Cited Medium: Print ISSN: 0028-3770 (Print) Linking ISSN: 00283770 NLM ISO Abbreviation: Neurochirurgie Subsets: MEDLINE
    • Publication Information:
      Original Publication: Paris : Masson
    • Subject Terms:
      Cerebral Revascularization/*methods ; Decompression, Surgical/*methods ; Hemifacial Spasm/*surgery; Adult ; Aged ; Cerebral Revascularization/adverse effects ; Cerebral Revascularization/mortality ; Decompression, Surgical/adverse effects ; Decompression, Surgical/mortality ; Electromyography ; Evoked Potentials, Auditory, Brain Stem/physiology ; Facial Nerve/surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Monitoring, Intraoperative ; Prognosis ; Recurrence ; Retrospective Studies ; Treatment Failure ; Treatment Outcome
    • Abstract:
      Background and Purpose: The results of a series of 100 patients operated on for hemifacial spasm (HFS), using microsurgical vascular decompression (MVD), are reported.
      Method: MVD was performed through a retromastoid keyhole approach, under monitoring of brainstem auditory evoked potentials (BAEP) and facial EMG, and consisted in dissection of VII nerve from conflicting vessel(s), and interposition of Teflon fibers and/or screen(s).
      Results: The offending vessels found were: the antero-inferior cerebellar artery in 57 cases, the postero-inferior cerebellar artery in 56 cases, the vertebrobasilar artery in 22 cases. A multiple conflict was found in 32 cases (32%). The result was considered excellent if there was no residual spasm, good if only "minimal twitching" remained with relief>80%, poor for spasm relief 20 to 80%, and as a failure if relief<20%. The effect of MVD was satisfying (excellent or good) in 75 patients (75%) at discharge (10th day) and in 85 (85%) after 1 to 18 years follow-up (mean: 5 years). Amongst the latter patients, 29 (34%) experienced a delayed (up to 3(1/2) years in one) cure. Spasm recurrence was noted in 9 cases after satisfying effect on discharge. We encountered following permanent neurological complications: 1 facial palsy, 7 cases of hearing deficit (5 of them complete), and 1 case of IX-X deficit. Neither death nor ischaemic complication at brainstem or cerebellum. Most of our hearing complications occurred before using intraoperative BAEP monitoring (3 cases of cophosis among our first 7 patients vs 2 out of our last 93). Local complications were: 1 meningitis, 8 cases of CSF leakage requiring either a series of lumbar punctures or a lumbar external drain, and 3 cases of wound infection and/or delayed woundhealing requiring surgical treatment.
      Conclusions: Our data are consistent with those of the literature, especially concerning high rate of long-term success and low complication rate of MVD for HFS. We do not recommend early re-operation in case of initial poor result. Again, the necessity of intraoperative BAEP monitoring to prevent hearing morbidity is highlighted.
    • Publication Date:
      Date Created: 20031204 Date Completed: 20040120 Latest Revision: 20061115
    • Publication Date:
      20240829
    • Accession Number:
      14646818