title: Long-term surgical results in microvascular decompression for hemifacial spasm: efficacy, morbidity and quality of life.
abstract: Hemifacial spasm is a condition that may severely reduce patients' quality of life. Microvascular decompression is the neurosurgical treatment of choice. The objective of this work was to describe the efficacy and morbidity of microvascular decompression for hemifacial spasm, evaluate the long-term efficacy on the quality of life and investigate prognostic factors for failure of the procedure. A retrospective study of 446 cases of hemifacial spasm treated by 511 retrosigmoid microvascular decompression over 22 years was conducted. Epidemiological, clinical and imaging findings, treatment modalities and outcomes of patients with pre- and postoperative HSF-8 quality of life questionnaire were studied. Success rate was 82% after first surgery and 91.6% after revision surgery. A low rate of perioperative morbidity was found. Facial palsy was mostly transient (5.5% transient and 0.2% permanent) and cochleovestibular deficit was seen in 4.8% of patients. Revision surgery increased nervous lesions (10.6% to 20.7%). Mean quality of life scores were significantly improved from 18 to 2 over 32, evaluated 7.3 years after surgery. Predictive factors of surgical failure were single conflicts (p = 0.041), atypical vasculo-nervous conflicts involving other vessel than postero-inferior cerebellar artery (p = 0.036), such as vein (p = 0.045), and other compression sites than root exit zone (p = 0.027). Retrosigmoid microvascular decompression is a safe and effective treatment of hemifacial spasm. Revision surgery is not to be excluded in case of failure, but does place patients at risk for more complications. Quality of life is improved in the long-term, indicating objective and subjective satisfaction.
authors.affiliation: Aix Marseille Université, IFSSTA R, LBA, UMR-T 24, Marseille, France;|APHM, Hôpital de la Conception, Service d'Oto-rhino-laryngologie et de Chirurgie cervico-faciale, Marseille, France;
authors.forename: M
authors.initials: M
authors.lastname: Montava
authors.affiliation: APHM, Hôpital de la Conception, Service d'Oto-rhino-laryngologie et de Chirurgie cervico-faciale, Marseille, France;
authors.forename: V
authors.initials: V
authors.lastname: Rossi
authors.affiliation: Hôpital Saint Musse, Service d'Otorhino- laryngologie et de Chirurgie cervico-faciale, Toulon, France;
authors.forename: C L
authors.initials: CL
authors.lastname: CurtoFais
authors.affiliation: Aix Marseille Université, INSERM, IRD, UMR912 SESSTIM, Marseille, France;|APHM, Hôpital de la Timone, BiosTIC, Service Biostatistique et Technologies de l'Information et de la Communication, Marseille, France;
authors.forename: J
authors.initials: J
authors.lastname: Mancini
authors.affiliation: Aix Marseille Université, IFSSTA R, LBA, UMR-T 24, Marseille, France;|APHM, Hôpital de la Conception, Service d'Oto-rhino-laryngologie et de Chirurgie cervico-faciale, Marseille, France;
authors.forename: J-P
authors.initials: JP
authors.lastname: Lavieille
mesh_terms: D005260:Female; D019569:Hemifacial Spasm / Q000601:surgery*; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects*; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: HFS-8 score; Hemifacial spasm; Microvascular decompression; Neurovascular conflict; Quality of life