====== Microvascular decompression for hemifacial spasm outcome ======

{{ ::hemifacial_spasm.png?200|}}

[[Microvascular decompression]] is an effective treatment option in elderly patients with [[hemifacial spasm]] as well as in younger patients. Age itself seems to be no relevant contraindication or, alternatively, risk factor regarding MVD
((Zhao H, Zhu J, Tang YD, Shen L, Li ST. Hemifacial Spasm: Comparison of Results between Patients Older and Younger than 70 Years Operated on with Microvascular Decompression. J Neurol Surg A Cent Eur Neurosurg. 2021 Jul 8. doi: 10.1055/s-0040-1721018. Epub ahead of print. PMID: 34237777.))

Given that [[postoperative]] delayed [[cure]] was unavoidable, even with accurate identification of the offending vessel and sufficient [[decompression]] of the [[root exit zone]], the delayed cure should be considered in patients undergoing [[reoperation]] due to lack of [[remission]] or [[relapse]] after the operation. Additionally, the timing of efficacy assessments should be delayed
((Li MW, Jiang XF, Wu M, He F, Niu C. Clinical Research on Delayed Cure after
Microvascular Decompression for Hemifacial Spasm. J Neurol Surg A Cent Eur
Neurosurg. 2019 Oct 10. doi: 10.1055/s-0039-1698461. [Epub ahead of print] PubMed
PMID: 31600810.
)).

The definitive treatment for [[hemifacial spasm]] is [[microvascular decompression]] (MVD), which cures the disease in 85% to 95% of patients according to reported series. In expert hands, the MVD procedure can be done with relatively low [[morbidity]].

Post-operatively, there may be episodes of mild HFS, however they usually begin to diminish 2–3 days following MVD. Severe spasm that does not abate suggests failure to achieve adequate decompression, and reoperation should be considered.

Surgical results of MVD depends on the duration of symptoms (shorter duration has better prognosis)
as well as on the age of the patient (elderly patients do less well). Complete resolution of HFS
occurred in 44 (81%) of 54 patients undergoing MVD, however, 6 of these patients had relapse
((Auger RG, Peipgras DG, Laws ER. Hemifacial Spasm:
Results of Microvascular Decompression of the
Facial Nerve in 54 Patients. Mayo Clin Proc. 1986;
61:640–644)).
5 patients (9%) had partial improvement, and 5 (9%) had no relief.


----
Complete resolution of spasm occurs in ≈ 85–93%
((Rhoton AL. Comment on Payner T D and Tew J M:
Recurren ce of Hemifacial Spasm After Microvascular
Decompression. Neurosurgery. 1996; 38))
((Jannetta PJ. Neurovascular Compression in Cranial
Nerve and Systemic Disease. Ann Surg. 1980;
192:518–525))
((Loeser JD, Chen J. Hemifacial Spasm: Treatment by
Microsurgical Facial Nerve Decompression. Neurosurgery.
1983; 13:141–146))
((Huang CI, Chen IH, Lee LS. Microvascular Decompression
for Hemifacial Spasm: Analyses of Operative
Findings and Results in 310 Patients.
Neurosurgery. 1992; 30:53–57))
((Payner TD, Tew JM. Recurrence of Hemifacial Spasm
After Microvascular Decompression. Neurosurgery.
1996; 38:686–691)).
Spasm is diminished in 9%, and unchanged in 6%
((Payner TD, Tew JM. Recurrence of Hemifacial Spasm
After Microvascular Decompression. Neurosurgery.
1996; 38:686–691)).
Of 29 patients with complete relief, 25 (86%) had immediate post-op resolution, and the remaining 4 patients took from 3 mos to 3 yrs to attain quiescence.

===== Recurrence =====

[[Recurrent hemifacial spasm after microvascular decompression]].

===== References =====