title: Effect of previous botulinum neurotoxin treatment on microvascular decompression for hemifacial spasm.
abstract: OBJECTIVE
  The objective of this study was to investigate the clinical characteristics, intraoperative findings, complications, and outcomes after the first microvascular decompression (MVD) in patients with and without previous botulinum neurotoxin treatment for hemifacial spasm (HFS).
  
  
  METHODS
  The authors analyzed 246 MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000, and December 31, 2007. One hundred and seventy-six patients with HFS underwent botulinum neurotoxin injection treatment prior to first MVD (Group I), and 70 patients underwent their first MVD without previous botulinum neurotoxin treatment (Group II). Clinical outcome data were obtained immediately after the operation, at discharge, and at follow-up. Follow-up data were collected from 177 patients with a minimum follow-up period of 9 months (mean 54.48 ± 27.84 months).
  
  
  RESULTS
  In 246 patients, 89.4% experienced immediate postoperative relief of spasm, 91.1% experienced relief at discharge, and 92.7% experienced relief at follow-up. There was no significant difference in outcomes and complications between Group I and Group II (p > 0.05). Preoperatively, patients in Group I had higher rates of facial weakness, tinnitus, tonus, and platysmal involvement as compared with Group II (p < 0.05). The posterior inferior cerebellar artery and vertebral artery were intraoperatively identified as the offending vessels in cases of vasculature compression in a significantly greater number of patients in Group II compared with Group I (p = 0.008 and p = 0.005, respectively, for each vessel). The lateral spread response (LSR) disappeared in 60.48% of the patients in Group I as compared with 74.19% in Group II (p > 0.05). No significant differences in complications were noted between the 2 groups.
  
  
  CONCLUSIONS
  Microvascular decompression is an effective and safe procedure for patients with HFS previously treated using botulinum neurotoxin. Intraoperative monitoring with LSR is an effective tool for evaluating adequate decompression.
authors: Department of Neurological Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors: Xuhui
authors: X
authors: Wang
authors: Parthasarathy D
authors: PD
authors: Thirumala
authors: Aalap
authors: A
authors: Shah
authors: Paul
authors: P
authors: Gardner
authors: Miguel
authors: M
authors: Habeych
authors: Donald J
authors: DJ
authors: Crammond
authors: Jeffrey
authors: J
authors: Balzer
authors: Michael
authors: M
authors: Horowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004172:Diplopia / Q000139:chemically induced; D004568:Electrodiagnosis; D004576:Electromyography; D016057:Evoked Potentials, Auditory, Brain Stem; D005155:Facial Nerve Diseases / Q000188:drug therapy / Q000601:surgery*; D005158:Facial Paralysis / Q000139:chemically induced; D005260:Female; D005500:Follow-Up Studies; D019569:Hemifacial Spasm / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009408:Nerve Compression Syndromes / Q000188:drug therapy / Q000601:surgery*; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A