gms | German Medical Science

Objective: Microvascular decompression represents the best definitive treatment of hemifacial spasm. The outcome of surgery is variable with percentage of recurrent spasms and other unfavorable manifestations like hearing dimution and facial paresis.

Methods: In this study, we performed a retrospective analysis of the prospectively collected database to detect the valuable predictors of the unfavorable recurrent or residual spasms directly after surgery and along the long-term postoperative follow up.

Results: We studied data of 413 surgical procedures performed to 387 patients. Among these 21 needed a redo operation, and 2 patients needed 3 surgeries. The follow-up interval reached 18 months in 268 patients. Several factors were analysed to detect which of them would be of value in predicting unfavorable outcome as: age, sex, offending vessels, grooving, site of grooving, and lateral spreads. Grooving, site of grooving and offending vessel(s) were the main factors that can predict unfavorable outcome with P value of 0.0111 ,0.0104, 0.0106 directly after surgery in the forementioned factors respectively. For the long-term follow-up, P value reached 0.0344 in site of grooving and 0.0004 in the offending vessel respectively. The worst outcome was with vertebral artery and/or posterior inferior cerebellar arteries as offending vessels.

Conclusion: Grooving at the compression site of the facial nerve, along with the compression with vertebral artery and/or PICA represent valuable predictors for the risk of worse outcome. The data for these predictors could be best obtained from the intraoperative endoscopic visualization of the neurovascular conflict at the compression site.