Factors Related to the Delayed Cure of Hemifacial Spasm after Microvascular Decompression: An Analysis of 175 Consecutive Patients

Abstract

Detailed studies assessing the factors related to delayed cure of hemifacial spasm (HFS) after microvascular decompression (MVD) are sparse. We aimed to evaluate the effect of 11 clinical factors on the time until the patient became spasm free after MVD. We enrolled 175 consecutive patients with HFS who underwent MVD between 2012 and 2018. The end point was defined as the time point at which the patient became spasm free based on the outpatient interview. Patients were divided into six groups depending on when they became spasm free after the operation, as follows: <7 days (n = 62), 7 days to 1 month (n = 28), 1 to 3 months (n = 38), 3 to 6 months (n = 25), 6 to 12 months (n = 17), and >12 months (n = 5). The median time to become spasm free after MVD was 30.0 days. Association of 11 factors (age, sex, laterality, number of offending arteries, vertebral artery compression, number of compression sites, compression at root detachment zone, preoperative Botox treatment, indentation of the brain stem on preoperative magnetic resonance image, transposition, and interposition) with spasm-free rate was assessed using the Cox's proportional hazards model. Spasm-free rate curve after MVD for the significant factor was obtained using the Kaplan–Meier method. In univariate and multivariate analyses, nontransposition was significantly related to delayed HFS cure after MVD (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.42, 0.87; p = 0.0068 and HR, 0.60; CI, 0.43, 0.85; p = 0.042, respectively). The spasm-free rate was higher in the transposition than in the nontransposition group (p = 0.0013). As shortening the time until spasm free after MVD improves patients' quality of life, transposition should be recommended. Prediction of spasm-free time could relieve the anxiety of postoperative patients.

Keywords

delayed cure - facial nerve - hemifacial spasm - microvascular decompression - transposition

Note

We have read the journal's position on issues involved in ethical publication and affirm that this article is consistent with those guidelines.

Ethical Approval

This retrospective study was approved by the Research Ethics Board at the Showa University School of Medicine (#3070). All procedures performed were in accordance with the latest version of the Declaration of Helsinki.

Consent to Participate

Informed consent was not required because the data were deidentified.

Availability of Data and Material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Authors' Contribution

Y.S. and K.S. conceptualized and designed the study, and critically revised the manuscript. All authors performed acquisition of data, analysis and interpretation of data. All authors also reviewed the submitted version of the manuscript and provided administrative/technical/material support. Y.S. drafted the article, approved the final version of the manuscript on behalf of all authors, and performed the statistical analysis. K.S. performed the study supervision.

Publication History

Received: 02 December 2020

Accepted: 12 November 2021

Article published online:
29 December 2021

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