RECURRENCE OF HEMIFACIAL SPASM AFTER MICROVASCULAR DECOMPRESSION

THE SUCCESS OF medical and surgical treatment for hemifacial spasm, an involuntary paroxysmal unilateral contraction of the facial muscles, has been mixed. Although microvascular decompression has the greatest reported success, symptom recurrence affects many patients in whom tre atment was initially successful. In this study, we report the results of 34 patients who underwent microvascular decompression of the facial nerve from 1976 to 1989 as well as review the literature concerning t he incidence and timing of recurrence in more than 600 patients who un derwent microvascular decompression. In this series, 94% of 34 patient s had continuous relief of spasm after surgical treatment (mean durati on, >6 yr). Of those patients whose spasms were completely initially r elieved, 10.3% developed some degree of recurrent spasm; however, no p atient developed a recurrence after 24 months without spasm. Our revie w of the literature discloses that 86% of all recurrences occurred wit hin 2 years of surgery. Patients who have no recurrence of symptoms 2 years after surgical treatment have only a 1% chance of developing rec urrent hemifacial spasm. We also comment on possible causes of treatme nt failure and recurrence of hemifacial spasm after surgical treatment .