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Journal of Korean Neurosurgical Society 1999;28(2): 181-189. |
| Treatment Results of the New Microsurgery in Hemifacial Spasm. |
| Young Jo Shin, Bong Arm Rhee, Jong Tae Park, Young Jin Lim, Tae Sung Kim, Won Leem, Gook Ki Kim |
| Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea. |
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| ABSTRACT |
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Hemifacial spasm is painless uncommon disorder characterized by involuntary paroxysmal movement of one side of face.
Microvascular decompression at root exit zone of the facial nerve has become the standard treatment for hemifacial spasm. An alternative hypothesis, proposed for the relieve of hemifacial spasm with microvascular decompression, actually result from minor trauma or circumferential fibrosis to a sensitive zone of the facial nerve. Upon the base of this hypothesis, author have treated patient with hemifacial spasm with surgical manipulation in addition to microvascular decompression.
During last fifteen years, 250 patients with hemifacial spasm underwent this operation. The age at operation ranged from 18 to 71 years, with mean over 45.7 years and the duration of symptoms averaged 5.8 years. The spasms occurred predominantly right side, 5 cases were bilateral. The common offending vessels were AICA in 127 cases(50.8%) and PICA in 50 cases(20%). The remainder were 17 cases in vertebral artery, 9 cases in labyrin-thine artery(3.6%) and multiple offending vessels were found in 29 cases(11.6%). In two hundred fifteen cases, the spasm was completely relieved within 5 days after operation. Among 25 cases whose spasm unrelieved initially after surgery, 19 cases was relieved within 3 weeks and 6 cases within 3 months. Complications following surgery is approximately 22.8%: the most commonly encountered deficit is facial weakness(16 cases) followed by CSF leak (12 cases), and some degree of hearing loss(12 cases). Other complications include wound infection, ataxia, pneumocephalus and focal hemorrhage. Surgical manipulation in addition to microvascular decompression for hemifacial spasm(a new combined approach) produces better results of improvement approximately up to 96%. |
| Key Words:
Hemifacial spasm; Microvascular decompression; Surgical manipulation; Offending vessels |
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