• Hua Zhao, Xin Zhang, Yin-da Tang, Jin Zhu, Ting-Ting Ying, Yuan Yan, and Shiting Li.
• Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
• World Neurosurg. 2017 Feb 1; 98: 872.e11-872.e19.

BackgroundMicrovascular decompression (MVD) has become the best treatment for hemifacial spasm (HFS); however, some patients do not obtain complete relief after the initial MVD. We analyzed a group of patients who underwent a second MVD, to identify the factors that prevented relief after the initial MVD and those that promote the success of the second procedure.MethodsOf a group of 1400 patients with typical primary unilateral HFS treated with MVD between January 2014 and October 2015, we focused on 42 patients with poor postoperative outcomes. All patients underwent abnormal muscle response (AMR) monitoring again the day after surgery. Of those patients, 35 underwent a second MVD surgery within a week. We analyzed their AMRs after each operation.ResultsAfter the first operation, AMR was positive in 40 patients and negative in 2 patients. The latter 2 patients reported spontaneous relief within 1 week. Among the 40 positive patients, 35 and 4 patients underwent a second MVD within a week and 6-11 months, respectively. Thirty-nine patients reported relief after the second MVD; 1 patient remained unchanged at follow-up (<12 months).ConclusionsWhen initial MVD does not provide relief, a repeat MVD should be performed as soon as possible. In 2/42 cases, relief was delayed enough that AMR had a false-negative result. Combinative monitoring of AMR and Z-L responses was important in identifying the real cause of HFS.Copyright © 2016 Elsevier Inc. All rights reserved.

26 keywords...

hide…