| Clinical Analysis of Facial Palsy after Microvascular Decompression in Patients with Hemifacial Spasm |
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Ji Young Moon, In Bo Han, Ryoong Huh, Jin Woo Chang, Sang Sup Chung |
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Department of Neurosurgery, University of Pochun CHA, Seongnam, Korea Department of Neurosurgery, University of Yonsei, Seoul, Korea |
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| Abstract |
Objective
The purpose of this study is to identify whether expectation of complications after microvascular decompression in
the patients with hemifacial spasm with application by the time of occurrence and the severity of them and to establish appropriate
treatment measures by classification.
Materials and Methods: Medical records and computerized data were retrospectively analyzed for 1,582 patients had received
microvascular decompression from 1978 to March 2005. Mean age of the patients was 49.2 years and average period of prevalence was 7.9 years. The gender ratio was 1：3.6 (male：female). The period of average postoperative follow-up was 30.9
months. Intraoperative auditory evoked potential monitoring was performed from June, 1982.
Results
Totally 645 patients (40.8%) suffered from postoperative complications, but 63 patients (3.99%) remained permanent
deficits. As the result of postoperative observation, 375 cases (23.7%) showed facial palsy. Of facial palsy occurred in the patients,
356 cases (94.9%) were transient and 19 cases (5.1%) were permanent. One hundred nine cases (6.9%) of hearing impairment
occurred：Seventy five cases (68.8%) were transient and 34 cases (31.2%) were permanent. In 39 cases (2.5%), facial palsy
and hearing impairment occurred concurrently. Facial palsy occurred in acute phase after operation: there was the trend that
the more severe, the more permanent disorders remained, with statistical significance. In hearing impairment the results had
almost same tendency but no statistical significance. The mean period for recovery from transient facial palsy was 6 weeks
(median was 4 weeks and standard deviation was 7.1 weeks). The average period for recovery from transient hearing impairment
was 10 weeks (median was 4 weeks and standard deviation was 13.9 weeks). The mean period for recovery from transient
lower cranial nerve palsy was 26.6 weeks and was longer than that of facial palsy or hearing impairment.
Conclusion
The overall complication rate was high (40.8%), but the permanent complication rate was relatively low (3.99%).
Facial palsy was the most common complication, wherever hearing impairment was the most serious complication. For determination of permanent complications requires two-year or longer follow-up observation after operation especially in case of
lower cranial nerve palsies. To reduce the occurrence of complications, monitoring of auditory evoked potential during operation,
shortening of operation time, rapid medication after occurrence of postoperative complications, and continuous physical therapy
are required. |
| Key Words:
Hemifacial spasm, Microvascular decompression, Complication, Facial palsy. |
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