Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 3/2022

Open Access 01-03-2022 | Facial Palsy | Original Article - Functional Neurosurgery - Other

A multivariable prediction model for recovery patterns and time course of symptoms improvement in hemifacial spasm following microvascular decompression

Authors: Ahmed Al Menabbawy, Ehab El Refaee, Reem Elwy, Amany A. Salem, Sebastian Lehmann, Marcus Vollmer, Marc Matthes, Steffen Fleck, Jörg Baldauf, Henry W. S. Schroeder

Published in: Acta Neurochirurgica | Issue 3/2022

Login to get access

Abstract

Background

Microvascular decompression (MVD) success rates exceed 90% in hemifacial spasm (HFS). However, postoperative recovery patterns and durations are variable.

Objective

We aim to study factors that might influence the postoperative patterns and duration needed until final recovery.

Method

Only patients following de-novo MVD with a minimum follow-up of 6 months were included. Overall trend of recovery was modeled. Patients were grouped according to recognizable clinical recovery patterns. Uni- and multivariable analyses were used to identify the factors affecting allocation to the identified patterns and time needed to final recovery.

Results

A total of 323 (92.6%) patients had > 90% symptom improvement, and 269 (77.1%) patients had complete resolution at the last follow-up. The overall trend of recovery showed steep remission within the first 6 months, followed by relapse peaking around 8 months with a second remission ~ 16 months. Five main recovery patterns were identified.
Pattern analysis showed that evident proximal indentation of the facial nerve at root exit zone (REZ), males and facial palsy are associated with earlier recovery at multivariable and univariable levels. anterior inferior cerebellar artery (AICA), AICA/vertebral artery compressions and shorter disease durations are related to immediate resolution of the symptoms only on the univariable level. Time analysis showed that proximal indentation (vs. distal indentation), males and facial palsy witnessed significantly earlier recoveries.

Conclusion

Our main finding is that in contrast to peripheral indentation, proximal indentation of the facial nerve at REZ is associated with earlier recovery. Postoperative facial palsy and AICA compressions are associated with earlier recoveries. We recommend a minimum of 1 year before evaluating the final outcome of MVD for HFS.
Literature
1.
Abdul-Wahab SA (2011) Sick building syndrome: in Public buildings and workplaces. Springer Science & Business Media
2.
3.
Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD (1996) The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 334(17):1077–1083CrossRef
4.
Barker FG, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD (1995) Microvascular decompression for hemifacial spasm. J Neurosurg 82(2):201–210CrossRef
5.
Campos-Benitez M, Kaufmann AM (2008) Neurovascular compression findings in hemifacial spasm. J Neurosurg 109(3):416–420CrossRef
6.
Chang WS, Chung JC, Kim JP, Chung SS, Chang JW (2012) Delayed recurrence of hemifacial spasm after successful microvascular decompression: follow-up results at least 5 years after surgery. Acta Neurochir 154(9):1613–1619CrossRef
7.
Chung SS, Chang JW, Kim SH, Chang JH, Park YG, Kim DI (2000) Microvascular decompression of the facial nerve for the treatment of hemifacial spasm: preoperative magnetic resonance imaging related to clinical outcomes. Acta Neurochir 142(8):901 (6 discussion 907)CrossRef
8.
Collins GS, Reitsma JB, Altman DG, Moons KGM (2015) Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD): the TRIPOD Statement. Br J Surg 102(3):148–158CrossRef
9.
Damaty AE, El Damaty A, Rosenstengel C, Matthes M, Baldauf J, Schroeder HWS (2016) The value of lateral spread response monitoring in predicting the clinical outcome after microvascular decompression in hemifacial spasm: a prospective study on 100 patients. Neurosurg Rev 39(3):455–466CrossRef
10.
De Ridder D, Møller A, Verlooy J, Cornelissen M, De Ridder L (2002) Is the root entry/exit zone important in microvascular compression syndromes? Neurosurgery 51(2):427–33 (discussion 433–4)CrossRef
11.
El Damaty A, Rosenstengel C, Matthes M, Baldauf J, Dziemba O, Hosemann W, Schroeder HWS (2017) A new score to predict the risk of hearing impairment after microvascular decompression for hemifacial spasm. Neurosurgery 81(5):834–843CrossRef
12.
El Refaee E, Langner S, Baldauf J, Matthes M, Kirsch M, Schroeder HWS (2013) Value of 3-dimensional high-resolution magnetic resonance imaging in detecting the offending vessel in hemifacial spasm: comparison with intraoperative high definition endoscopic visualization. Neurosurgery 73(1):58–67 (discussion 67)CrossRef
13.
El Refaee E, Langner S, Marx S, Rosenstengel C, Baldauf J, Schroeder HWS (2019) Endoscope-assisted microvascular decompression for the management of hemifacial spasm caused by vertebrobasilar dolichoectasia. World Neurosurg 121:e566–e575CrossRef
14.
El Refaee E, Marx S, Rosenstengel C, Baldauf J, Schroeder HWS (2020) Arachnoid bands and venous compression as rare causes of hemifacial spasm: analysis of etiology in 353 patients. Acta Neurochir 162(1):211–219CrossRef
15.
Fleming GWTH, Fleming GWT (1938) Structure of the nerve root. I. Nature of the junction between the central and the peripheral nervous system. (Arch. Neur. and Psychiat., vol. xxxvii, p. 555, March, 1937.) Tarlov, I. M. J Ment Sci 84(48):225–225CrossRef
16.
Guclu B, Sindou M, Meyronet D, Streichenberger N, Simon E, Mertens P (2011) Cranial nerve vascular compression syndromes of the trigeminal, facial and vago-glossopharyngeal nerves: comparative anatomical study of the central myelin portion and transitional zone; correlations with incidences of corresponding hyperactive dysfunctional syndromes. Acta Neurochir 153(12):2365–2375CrossRef
17.
Jin Y, Zhao C, Su S, Zhang X, Qiu Y, Jiang J (2015) Residual hemifacial spasm after microvascular decompression: prognostic factors with emphasis on preoperative psychological state. Neurosurg Rev 38(3):567–72 (discussion 572)CrossRef
18.
Jo KW, Kong DS, Park K (2013) Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure. Neurosurg Rev 36(2):297–301 (discussion 301–2)CrossRef
19.
Kim YG, Chang WS, Jung HH, Chang JW (2019) The long-term effects of microvascular decompression on social phobia and health-related quality of life in patients with hemifacial spasm: a 3-year prospective study. Acta Neurochir 161(10):2035–2042CrossRef
20.
Kim JP, Chung JC, Chang WS, Chung SS, Chang JW (2012) Outcomes of surgical treatment for hemifacial spasm associated with the vertebral artery: severity of compression, indentation, and color change. Acta Neurochir 154(3):501–508CrossRef
21.
Kim HR, Rhee D-J, Kong D-S, Park K (2009) Prognostic factors of hemifacial spasm after microvascular decompression. J Korean Neurosurg Soc 45(6):336–340CrossRef
22.
Ladwig KH, Marten-Mittag B, Formanek B, Dammann G (2000) Gender differences of symptom reporting and medical health care utilization in the German population. Eur J Epidemiol 16(6):511–518CrossRef
23.
Lee J-A, Kim K-H, Kong D-S, Lee S, Park S-K, Park K (2019) Algorithm to predict the outcome of microvascular decompression for hemifacial spasm: a data-mining analysis using a decision tree. World Neurosurg 125:e797–e806CrossRef
24.
Lee J-A, Park K (2019) Short-term versus long-term outcomes of microvascular decompression for hemifacial spasm. Acta Neurochir 161(10):2027–2033CrossRef
25.
Lee JM, Park HR, Choi YD, Kim SM, Jeon B, Kim H-J, Kim DG, Paek SH (2018) Delayed facial palsy after microvascular decompression for hemifacial spasm: friend or foe? J Neurosurg 129(2):299–307CrossRef
26.
Li S, Feng B, Xie C, You C, Wei X, Zheng X (2016) Good surgical outcomes of hemifacial spasm patients with obvious facial nerve indentation and color change. World Neurosurg 92:218–222CrossRef
27.
28.
Mizobuchi Y, Muramatsu K, Ohtani M, Satomi J, Fushimi K, Matsuda S, Nagahiro S (2017) The current status of microvascular decompression for the treatment of hemifacial spasm in Japan: an analysis of 2907 patients using the Japanese diagnosis procedure combination database. Neurol Med Chir 57(4):184–190CrossRef
29.
Møller AR (1991) The cranial nerve vascular compression syndrome: II. A review of pathophysiology Acta Neurochir 113(1–2):24–30CrossRef
30.
Montava M, Rossi V, CurtoFais CL, Mancini J, Lavieille J-P (2016) Long-term surgical results in microvascular decompression for hemifacial spasm: efficacy, morbidity and quality of life. Acta Otorhinolaryngol Ital 36(3):220–227CrossRef
31.
Nomura K, Ryu H, Ohno K, Sato K (2021) Wide distribution of central myelin segment along the facial nerve might explain hemifacial spasm with distal nerve compression. Clin Anat 34(3):405–410CrossRef
32.
Oh E-T, Kim E, Hyun D-K, Yoon SH, Park H, Park H-C (2008) Time course of symptom disappearance after microvascular decompression for hemifacial spasm. J Korean Neurosurg Soc 44(4):245–248CrossRef
33.
Park K, Hong SH, Hong SD, Cho Y-S, Chung W-H, Ryu NG (2009) Patterns of hearing loss after microvascular decompression for hemifacial spasm. J Neurol Neurosurg Psychiatry 80(10):1165–1167CrossRef
34.
Park JS, Kong DS, Lee JA, Park K (2008) Chronologic analysis of symptomatic change following microvascular decompression for hemifacial spasm: value for predicting midterm outcome. Neurosurg Rev 31(4):413–8 (discussion 418–9)CrossRef
35.
Refaee EE, Rosenstengel C, Baldauf J, Pillich DT, Matthes M, Schroeder HWS (2018) Microvascular decompression for patients with hemifacial spasm associated with common trunk anomaly of the cerebellar arteries—case study and review of literature. Oper Neurosurg (Hagerstown) 14(2):121–127CrossRef
36.
Sindou M, Mercier P (2018) Microvascular decompression for hemifacial spasm: outcome on spasm and complications. A review Neurochirurgie 64(2):106–116CrossRef
37.
Soriano-Baron H, Vales-Hidalgo O, Arvizu-Saldana E, Moreno-Jimenez S, Revuelta-Gutierrez R (2015) Hemifacial spasm: 20-year surgical experience, lesson learned. Surg Neurol Int 6(1):83CrossRef
38.
Stenberg B, Wall S (1995) Why do women report “sick building symptoms” more often than men? Soc Sci Med 40(4):491–502CrossRef
39.
Tandon PN, Ramamurthi R (2012) Textbook of neurosurgery, third edition, three, vol set. Jaypee Brothers Medical Publishers Pvt, Limited
40.
41.
Tomii M, Onoue H, Yasue M, Tokudome S, Abe T (2003) Microscopic measurement of the facial nerve root exit zone from central glial myelin to peripheral Schwann cell myelin. J Neurosurg 99(1):121–124CrossRef
42.
Wang X, Thirumala PD, Shah A, Gardner P, Habeych M, Crammond D, Balzer J, Burkhart L, Horowitz M (2013) The role of vein in microvascular decompression for hemifacial spasm: a clinical analysis of 15 cases. Neurol Res 35(4):389–394CrossRef
43.
Wickham H (2016) Data analysis. In: Wickham H (ed) ggplot2: elegant graphics for data analysis. Springer International Publishing, Cham, pp 189–201CrossRef
44.
Yee G-T, Yoo C-J, Han S-R, Choi C-Y (2014) Microanatomy and histological features of central myelin in the root exit zone of facial nerve. J Korean Neurosurg Soc 55(5):244CrossRef
Metadata
Title
A multivariable prediction model for recovery patterns and time course of symptoms improvement in hemifacial spasm following microvascular decompression
Authors
Ahmed Al Menabbawy
Ehab El Refaee
Reem Elwy
Amany A. Salem
Sebastian Lehmann
Marcus Vollmer
Marc Matthes
Steffen Fleck
Jörg Baldauf
Henry W. S. Schroeder
Publication date
01-03-2022
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 3/2022
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-022-05133-w

Other articles of this Issue 3/2022

Acta Neurochirurgica 3/2022 Go to the issue

Original Article - Infection

Combined use of vancomycin powder and betadine irrigation lowers the incidence of postcraniotomy wound infection in low-risk cases: a single-center risk-stratified cohort analysis

Original Article - Brain trauma

Prognosis in moderate-severe traumatic brain injury in a Swedish cohort and external validation of the IMPACT models

Original Article - Vascular Neurosurgery - Aneurysm

The role of microsurgery for poor-grade aneurysmal subarachnoid hemorrhages in the endovascular era

How I Do it - Tumor - Other

How I do it: minimally invasive resection of a sub-ependymoma of the fourth ventricle

Technical Note - Neurosurgical technique evaluation

The “springform” technique in cranioplasty: custom made 3D-printed templates for intraoperative modelling of polymethylmethacrylate cranial implants

Letter to the editor - History of Neurosurgery

Some historical remarks on ipsilateral hemiparesis and the absence of decussation of the pyramidal tracts