Article
Time course of symptoms resolution following microvascular decompression in hemifacial spasm – the Greifswalder-Experience
Zeitverlauf der Symptombefreiung nach mikrovaskulärer Dekompression bei Hemispasmus facialis – die Greifswalder-Erfahrung
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Authors
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Ahmed Al Menabbawy
- University Medicine Greifswald, Department of Neurosurgery, Greifswald, Deutschland; Kasr Alainy school of Medicine, Neurosurgery, Kairo, Ägypten
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Ehab Elrefaee
- University Medicine Greifswald, Department of Neurosurgery, Greifswald, Deutschland; Kasr Alainy School of Medicine, Neurosurgery, Kairo, Ägypten
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Reem Elwy
- Kasr Alainy School of Medicine, Neurosurgery, Kairo, Ägypten
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Henry W. S. Schroeder
- University Medicine Greifswald, Department of Neurosurgery, Greifswald, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Microvascular decompression (MVD) success rates reach 90% in hemifacial spasm (HFS). However, the postoperative course and duration of resolution of the symptoms remain quite variable. The aim of this study is to analyze the different prognostic factors that might determine the postoperative patterns and duration needed until the final recovery is reached.
Methods: A retrospective review of our microvascular decompression database was performed, 287 patients following de-novo MVD, with a minimum follow-up of 6 months were included. Data of the second operation in patients who were operated more than once were excluded. The overall trend of postoperative recovery was modeled. Patients were grouped according to the recognizable recovery patterns. Uni- and multivariable regression analysis was used to identify the factors affecting allocation to the identified patterns, the time needed to initial and final resolution of the symptoms and relapse.
Results: The overall trend of the postoperative course showed improvement by <6 months, followed by relapse peaking around 8 months with a steep remission starting at the 13th postoperative month. Five main recovery patterns were identified: Among statistically significant independent predictors of allocation to the defined patterns was the location of grooving. 257 patients (89,5%) completely recovered postoperatively. Regarding time to initial recovery, AICA (HR: 1.42; CI 1.03-1.98), or >1 vessel compression (HR: 1.42; CI 1.06-1.90), showed a lower hazard of not recovering, and peripheral grooving showed an increased hazard of not recovering (HR: 0.56; CI 0.38-0.81). 114 patients (39.9%) experienced one or more relapses. A statistically significant protective factor for relapse was brainstem grooving (OR: 0.43; CI 0.19-0.90).
Conclusion: We recommend at least 1 year before evaluating the outcome following MVD and deciding to re-operating. In contrast to central brain stem indentation of the facial nerve, peripheral indentation as well as compressions caused by PICA are associated with delayed recovery. Brainstem grooving might be protective against relapse of the symptoms following initial recovery.
