An analysis of failed microvascular decompression in patients with hemifacial spasm: focused on the early reoperative findings.
BACKGROUND
Although the microvascular decompression (MVD) has become a definitive treatment for the primary hemifacial spasm (HFS), there still are some failed cases. To obtain a satisfactory postoperative outcome, those failure cases of MVD need to be analyzed.


METHODS
Between January and October 2009, 393 patients with primary HFS underwent MVD. Postoperatively, 375 presented complete spasm-free, 7 improved apparently, and 11 without any improvement at all. A reoperation was performed in 9 of the 11 patients who had poor outcome within 5 days. Those redo MVD cases were reviewed.


RESULTS
After the reoperation, the symptom of those patients all disappeared immediately. Therefore, the final outcomes were excellent in 97.7%, good in 1.8%, and poor in 0.5%. Up to the 1 year follow-up period, neither recurrence nor change was found. For the two patients without reoperation, their symptoms remained. The previous surgery was a failure due to insufficient decompression in two and conflict missed in seven.


CONCLUSIONS
A successful MVD operation is attributable to a thorough exploration of the entire nerve course. An early relief should become the ambition of the operator while performing MVD.
Zhong
Jun
J
Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, China. ZhongMDPhD@sjtu.edu.cn
Zhu
Jin
J
Li
Shi-Ting
ST
Li
Xin-Yuan
XY
Wang
Xu-Hui
XH
Yang
Min
M
Wan
Liang
L
Guan
Hong-Xin
HX
D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D005155:Facial Nerve Diseases / Q000473:pathology / Q000601:surgery*; D005260:Female; D019569:Hemifacial Spasm / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult