Cause analysis of recurrence or ineffectiveness after microvascular decompression for primary hemifacial spasm and efficacy of reoperation
Objective To investigate the reasons for the recurrence or ineffectiveness after microvascular decompression(MVD)for primary hemifacial spasm(HFS),as well as the strategies and efficacy of reoperation.Methods A retrospective analysis was conducted on the clinical data of 55 patients with recurrent or ineffective HFS after MVD,treated by the same surgeon in the Department of Neurosurgery at the China-Japan Friendship Hospital from February 2023 to April 2024.All patients underwent reoperation.Based on intraoperative findings,the reasons for recurrence or ineffectiveness were categorized into 3 types:Type Ⅰ involved severe adhesion between the original padding and the facial nerve and its root exit zone(REZ);Type Ⅱ resulted from the omission of vessels(mainly anterior inferior cerebellar artery and/or posterior inferior cerebellar artery)during the first surgery;and Type Ⅲ occurred when offending vessels were not completely and effectively decompressed,meaning that part of the offending vessels continued to compress the REZ and/or facial nerve.Corresponding reoperation strategies were employed for different types of reasons.The Cohen-Albert scoring system was used to assess the degree of hemifacial spasm relief postoperatively.All patients underwent clinical follow-up,and the surgical efficacy and complications were documented.Results Among the 55 patients,28 experienced recurrence,and 27 showed ineffectiveness after the initial MVD.Among the 28 recurrent cases,18 were Type Ⅰ(64.3％),7 were Type Ⅱ(25.0％),and 3 were Type Ⅲ(10.7％).Among the 27 ineffective cases,there was 21 cases of Type Ⅱ(77.8％),and 1(11.1％)of Type Ⅰ and 1(11.1％)of Type Ⅲ.Of the 28 missed offending vessels,14(50.0％)were anterior inferior cerebellar artery(AICA),9(32.1％)were posterior inferior cerebellar artery(PICA),and 5(17.9％)were vertebral artery complex.Among the 6 cases where offending vessels were not fully decompressed,4 were AICA,and 2 were PICA.According to the different types,the corresponding reoperation treatment strategy was adopted.The 55 patients were followed up for 2-18(mean:7.2±2.1)months.At the last follow-up,the postoperative Cohen-Albert scores were 0 in 52 patients,1 in 1 patient,and 2 in 2 patients.The cure rate was 94.5％(52/55),and the effective rate was 96.4％(53/55).During the follow-up,9 patients(16.4％)experienced varying degrees of facial paralysis,and 6 patients(10.9％)had impaired hearing.Conclusion For patients with HFS experiencing recurrence or ineffectiveness after MVD,categorizing the causes based on intraoperative findings and employing targeted reoperation strategies for different types are effective and safe for treating such patients.
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