Microvascular decompression for hemifacial spasm: Long-term results from 114 operations performed without neurophysiological monitoring

Mark Dannenbaum, Bradley C. Lega, Dima Suki, Richard L. Harper, Daniel Yoshor

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Object. Microvascular decompression (MVD) of the facial nerve is an effective treatment for hemifacial spasm (HFS), but the procedure is associated with a significant risk of complications such as hearing loss and facial weakness. Many surgeons advocate the use of intraoperative brainstem auditory evoked response (BAER) monitoring in an attempt to improve surgical outcomes. The authors critically assessed a large series of patients with HFS who underwent MVD without neurophysiological monitoring. Methods. The authors retrospectively identified 114 consecutive patients, with a history of HFS and without a history of HFS surgery, in whom MVD was performed by a single surgeon without the use of neurophysiological monitoring. Postoperative outcomes were determined by reviewing records and through telephone interviews. At least 1 year of postoperative follow-up data were available for 91 of the 114 patients, and the median follow-up duration in all cases was 8 years (range 3 months-23 years). A Kaplan-Meier analysis showed that 86% of the patients were spasm free at 10 years postoperatively. Results. There were no surgical deaths or major deficits, and complications included 1 case of postoperative deafness, 1 of permanent subtotal hearing loss, and 10 of delayed facial palsy, 2 of which did not completely resolve at last follow-up. The outcomes, rates of hearing loss, and other complications compared well with those reported in studies in which investigators used intraoperative monitoring. Conclusions. The results suggest that MVD without neurophysiological monitoring is a safe and effective treatment option in patients with HFS. Although BAER monitoring may be a valuable adjunct to surgery at centers experienced with the modality, the absence of intraoperative monitoring should not prevent neurosurgeons from performing MVD in patients with HFS.

Original languageEnglish (US)
Pages (from-to)410-415
Number of pages6
JournalJournal of Neurosurgery
Volume109
Issue number3
DOIs
StatePublished - Sep 2008

Fingerprint

Neurophysiological Monitoring
Microvascular Decompression Surgery
Hemifacial Spasm
Hearing Loss
Intraoperative Monitoring
Brain Stem Auditory Evoked Potentials
Facial Paralysis
Facial Nerve
Kaplan-Meier Estimate
Spasm
Deafness
Research Personnel
Interviews
Therapeutics

Keywords

  • Brainstem auditory evoked response
  • Hemifacial spasm
  • Microvascular decompression
  • Neurophysiological monitoring

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Microvascular decompression for hemifacial spasm : Long-term results from 114 operations performed without neurophysiological monitoring. / Dannenbaum, Mark; Lega, Bradley C.; Suki, Dima; Harper, Richard L.; Yoshor, Daniel.

In: Journal of Neurosurgery, Vol. 109, No. 3, 09.2008, p. 410-415.

Research output: Contribution to journalArticle

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abstract = "Object. Microvascular decompression (MVD) of the facial nerve is an effective treatment for hemifacial spasm (HFS), but the procedure is associated with a significant risk of complications such as hearing loss and facial weakness. Many surgeons advocate the use of intraoperative brainstem auditory evoked response (BAER) monitoring in an attempt to improve surgical outcomes. The authors critically assessed a large series of patients with HFS who underwent MVD without neurophysiological monitoring. Methods. The authors retrospectively identified 114 consecutive patients, with a history of HFS and without a history of HFS surgery, in whom MVD was performed by a single surgeon without the use of neurophysiological monitoring. Postoperative outcomes were determined by reviewing records and through telephone interviews. At least 1 year of postoperative follow-up data were available for 91 of the 114 patients, and the median follow-up duration in all cases was 8 years (range 3 months-23 years). A Kaplan-Meier analysis showed that 86{\%} of the patients were spasm free at 10 years postoperatively. Results. There were no surgical deaths or major deficits, and complications included 1 case of postoperative deafness, 1 of permanent subtotal hearing loss, and 10 of delayed facial palsy, 2 of which did not completely resolve at last follow-up. The outcomes, rates of hearing loss, and other complications compared well with those reported in studies in which investigators used intraoperative monitoring. Conclusions. The results suggest that MVD without neurophysiological monitoring is a safe and effective treatment option in patients with HFS. Although BAER monitoring may be a valuable adjunct to surgery at centers experienced with the modality, the absence of intraoperative monitoring should not prevent neurosurgeons from performing MVD in patients with HFS.",
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