title: Indications and Timings of Re-operation for Residual or Recurrent Hemifacial Spasm after Microvascular Decompression: Personal Experience and Literature Review.
abstract: We reviewed reports about the postoperative course of hemifacial spasm (HFS) after microvascular decompression (MVD), including in our own patients, and investigated treatment for delayed resolution or recurrence of HFS. Symptoms of HFS disappear after surgery in many patients, but spasm persists postoperatively in about 10-40%. Residual spasm also gradually decreases, with rates of 1-13% at 1 year postoperatively. However, because delayed resolution is uncommon after 1 year postoperatively, the following is advised: (1) In patients with residual spasms after 1 year postoperatively (incomplete cure) or who again experience spasm ≥ 1 year postoperatively (recurrence), re-operation is recommended if the spasms are worse than before MVD. (2) When re-operation is considered, preoperative magnetic resonance imaging (MRI) findings and intraoperative videos should be reviewed to ensure that no compression due to a small artery or vein was missed, and to confirm that adhesions with the prosthesis are not causing compression. If any suspicious findings are identified, the cause must be eliminated. Moreover, because of the risk of nerve injury, decompression of the distal portion of the facial nerve should be performed only in patients in whom distal compression is strongly suspected to be the cause of symptoms. (3) Cure rates after re-operation are high, but complications such as hearing impairment and facial weakness have been reported in 10-20% of cases, so surgery must be performed with great care.
authors.affiliation: Department of Neurosurgery, Mito Brain Heart Center.
authors.forename: Toru
authors.initials: T
authors.lastname: Hatayama
authors.forename: Takuji
authors.initials: T
authors.lastname: Kono
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Harada
authors.forename: Keiichi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Utsunomiya
authors.forename: Mototaka
authors.initials: M
authors.lastname: Hayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
authors.forename: Ryo
authors.initials: R
authors.lastname: Hatanaka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shimada
authors.forename: Atsuhito
authors.initials: A
authors.lastname: Takemura
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Tabata
authors.forename: Hana
authors.initials: H
authors.lastname: Tobishima
mesh_terms: D019569:Hemifacial Spasm / Q000601:surgery*; D006801:Humans; D061145:Microvascular Decompression Surgery; D018482:Muscle, Skeletal / Q000503:physiopathology; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation