• Xiao-Li Xu, Xue-Ke Zhen, Yue Yuan, Hong-Ju Liu, Jiang Liu, Jun Xu, Xiu-Bin Li, Li Zhang, and Yan-Bing Yu.
• Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China.
• World Neurosurg. 2018 Feb 1; 110: e989-e997.

ObjectiveAlthough repeat microvascular decompression (MVD) for hemifacial spasm (HFS) in patients with failed prior MVD is potentially curative, little is known about the long-term results of repeat MVD. We aimed to evaluate the long-term outcomes and complications after repeat MVD for HFS.MethodsWe performed repeat MVD on 78 consecutive patients who had undergone a prior MVD >1 year previously. Follow-up data were available for 58 patients, with a median follow-up period of 8.6 years (range, 6.9-10.2 years). The patients were assessed for intraoperative findings, relief results, and complications at discharge and at follow-up, as well as the associations between the preoperative characteristics and outcomes.ResultsAt discharge, of 78 patients with repeat MVD, 72 (92.3%) achieved complete spasm resolution and 1 (2.6%) had significantly improved spasm resolution. Of all patients, 9% (7 of 78) presented short-term complications, including partial hearing loss, hemifacial paresis, and cerebrospinal fluid leak. At follow-up, 45 of 58 (77.6%) patients had complete relief and 10 of 58 (17.2%) had improved relief. Permanent complications occurred in 14 patients (24.1%), with partial hearing loss and mild hemifacial paresis being the most common. Despite the complications, 51 of 58 patients (91.4%) reported an excellent life quality. No significant correlation was found between preoperative characteristics, such as age, interval to prior MVD, or interval to recurrence, and outcomes including short-term or long-term relief results and complications.ConclusionsRepeat MVD provides lasting relief for most patients with persistent or recurrent HFS, albeit with a relatively high complication rate.Copyright © 2017 Elsevier Inc. All rights reserved.

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