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      Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure.

      1 , ,

      Neurosurgical review

      Springer Nature America, Inc

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          Abstract

          The postoperative course of microvascular decompression (MVD) for hemifacial spasm (HFS) is variable, and the optimal time for assessing the results is unclear. From April 1997 to October 2007, MVD for HFS was performed in 801 patients. Patients were divided into two groups (cured or failed) according to subjective patient assessments over a 3-year period. We analyzed patient characteristics and surgical findings to determine prognostic factors. Medical records were analyzed retrospectively over the 3-year follow-up period. Of the 801 patients who underwent surgery, 743 (92.8 %) appeared to be cured, 70 (8.7 %) had residual or recurrent spasms more than 1 year after surgery, 11 (1.3 %) had gradual improvement over 3 years, and 1 (0.1 %) had delayed improvement more than 3 years after surgery. Fifty-eight patients (7.2 %) had residual or recurrent spasms more than 3 years after surgery, of which 19 (2.4 %) had recurrence after initial relief. The mean time to spasm recurrence was 18.9 months. Intraoperative resolution of the lateral spread response (LSR) after decompression (p = 0.048) and severe indentation (p = 0.038) were significant predictors of good long-term outcome after MVD for HFS. In our series, 70 patients (8.7 %) had residual or recurrent spasms more than 1 year after surgery, of which 12 (17.1 %) improved gradually after 1 year. If the surgeon can confirm intraoperative resolution of the LSR and severe indentation, reoperation can be delayed until 3 years after MVD.

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          Author and article information

          Journal
          Neurosurg Rev
          Neurosurgical review
          Springer Nature America, Inc
          1437-2320
          0344-5607
          Apr 2013
          : 36
          : 2
          Affiliations
          [1 ] Department of Neurosurgery, The Catholic University of Korea College of Medicine, Bucheon St. Mary's Hospital, Bucheon, South Korea. jkw94@naver.com
          Article
          10.1007/s10143-012-0420-3
          22940822
          ccf0d46c-d645-494f-a3eb-c21a00b1eb34

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