title: Management of Bilateral Hemifacial Spasm with Microvascular Decompression.
abstract: BACKGROUND
  Bilateral hemifacial spasm (HFS) is very rare. The literature contains only 32 clinical reports. Although microvascular decompression (MVD) is widely accepted as effective therapy for HFS, the etiology and surgical treatment of bilateral HFS are seldom addressed. We report our experience with MVD for patients with bilateral HFS.
  
  
  METHODS
  This retrospective report included 10 patients with bilateral HFS. All patients underwent MVD 1 or 2 times and were followed for 5-92 months. The clinical data were retrospectively analyzed. The etiology and treatment strategies were discussed.
  
  
  RESULTS
  Spasm stopped completely on the operative side in all 10 patients. Symptoms on the other side also resolved in 3 patients, improved in 1 patient, and did not improve at all in 6 patients. Of the 6 patients with no improvement, 5 underwent another MVD on the contralateral side within 1 year and experienced relief of symptoms, and 1 patient refused the surgery. The neurovascular conflict was found in all the operations. During the follow-up period, no complications of hearing loss or facial palsy and no recurrence were observed.
  
  
  CONCLUSIONS
  Vascular compression was the cause of bilateral HFS in our patients, and MVD relieved the symptoms. Thus, we recommend MVD for patients with bilateral HFS. A crowded cerebellopontine angle space and easy attrition of the neurovascular interfaces may play important roles in the occurrence of bilateral HFS. For some patients, 1 MVD can resolve bilateral symptoms.
authors.affiliation: Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China.
authors.forename: Ning-Ning
authors.initials: NN
authors.lastname: Dou
authors.affiliation: Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China. Electronic address: ZhongMDPhD@sjtu.edu.cn.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhong
authors.affiliation: Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China.
authors.forename: Ming-Xing
authors.initials: MX
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Xia
authors.affiliation: Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China.
authors.forename: Shi-Ting
authors.initials: ST
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002530:Cerebellopontine Angle / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D019569:Hemifacial Spasm / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bilateral; Etiology; Hemifacial spasm; Microvascular decompression; Surgery