MICROVASCULAR DECOMPRESSION FOR HEMIFACIAL SPASM

The authors report the results of 782 microvascular decompression proc edures for hemifacial spasm in 703 patients (705 sides), with follow-u p study from 1 to 20 years (mean 8 years). Of 648 patients who had not undergone prior intracranial procedures for hemifacial spasm, 65% wer e women; their mean age was 52 years, and the mean preoperative durati on of symptoms was 7 years. The onset of symptoms was typical in 92% a nd atypical in 8%. An additional 57 patients who had undergone prior m icrovascular decompression elsewhere were analyzed as a separate group . Patients were followed prospectively with annual questionnaires. Kap lan-Meier methods showed that among patients without prior microvascul ar decompression elsewhere, 84% had excellent results and 7% had parti al success 10 years postoperatively. Subgroup analyses (Cox proportion al hazards model) showed that men had better results than women, and p atients with typical onset of symptoms had better results than those w ith atypical onset. Nearly all failures occurred within 24 months of o peration; 9% of patients underwent reoperation for recurrent symptoms. Second microvascular decompression procedures were less successful, w hether the first procedure was performed at Presbyterian-University Ho spital or elsewhere, unless the procedure was performed within 30 days after the first microvascular decompression. Patient age, side and pr eoperative duration of symptoms, history of Hell's palsy, preoperative presence of facial weakness or synkinesis, and implant material used had no influence on postoperative results. Complications after the fir st microvascular decompression for hemifacial spasm included ipsilater al deaf ear in 2.6% and ipsilateral permanent, severe facial weakness in 0.9% of patients. Complications were more frequent in reoperated pa tients. In all, one operative death (0.1%) and two brainstem infarctio ns (0.3%) occurred. Microvascular decompression is a safe and definiti ve treatment for hemifacial spasm with proven long-term efficacy.