Microsurgical treatment of facial hemispasm

Sitnikov A. R., Grigoryan Yu. A.

Keywords: hemifacial spasm, microsurgical decompression, vascular compression

Objectives: to analyse the intra-operative findings and results of microsurgical treatment of patients with hemifacial spasm.

Materials and methods: 35 patients with hemifacial spasm were operated applying the method of microsurgical vascular decompression. Surgery was performed via retromastoidal approach with following transposition of intracranial vessels or tumour resection and implantation of various protective systems between the vessels, cranial nerves and brain stem.

Results: The mean age of patients was 49 years (between 20 and 77 years). There were 27 females and 8 males (F:M ratio = 1: 0.29). The MRI showed vascular compression of facial nerve root in 26 cases and its compression by tumour in one case. Intra-operatively compression by single vessel was revealed in 26 patients, and 9 patients had multiple compression. In 10 cases the neurovascular conflict was due to vertebral artery, in 15 cases – posterior inferior cerebellar artery, 16 cases – anterior inferior cerebellar artery, 1 case – long circumflex brain stem artery, 1 case – basilar artery and venous compression was found in one patient. The microvascular decompression was done in 33 cases; in one case the complete procedure wasn’t done because the penetration of facial nerve roots by the artery. The tumour resection was done in one case. After the surgery 33 patients had excellent outcomes.

CONCLUSION: the microsurgical decompression of nerves roots is the highly effective method of surgical treatment of facial hemispasm, characterised by the remaining of nerves functions and low re-occurrence rate.

Eur. J Neurol. 2008 Aug;15 Suppl 3.Р-1370 Abstracts of the 12th Congress of the European Federation of Neurological Societies (EFNS). Madrid, Spain. August 24-26, 2008.