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.
Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, China. ZhongMDPhD@sjtu.edu.cn
Jun
J
Zhong
Jin
J
Zhu
Shi-Ting
ST
Li
Xin-Yuan
XY
Li
Xu-Hui
XH
Wang
Min
M
Yang
Liang
L
Wan
Hong-Xin
HX
Guan
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