The Effect of Microvascular Decompression on Hemifacial Spasm With Atherosclerosis of Vertebral Artery.

BACKGROUND: Microvascular decompression (MVD) is the most useful treatment for hemifacial spasm (HFS). In patients of vertebral artery (VA) compression of the facial nerve, MVD is often difficult. Many of the VA are obviously atherosclerotic. In this study, the authors retrospectively compared the effect of MVD for HFS associated with the atherosclerosis of vertebral artery (aVA) with that of MVD for HFS with normal vertebral artery (nVA).

METHODS: A retrospective study of HFS treated by MVD was conducted between January 2014 and October 2015. There were 186 patients with VA-associated HFS who underwent their first MVD at the authors' institution. Among them, 52 patients of HFS were associated with aVA and 134 patients were associated with nVA.

RESULTS: At 1 day, 7 days, 1 month, 3 months, and 1 year after MVD surgery, in aVA group, the effective rate of MVD was 80.77%, 80.77%, 82.00%, 79.59%, and 82.61%, the incidence rate of complication was 15.83%, 13.46%, 14.00%, 12.24%, and 10.87%; in nVA group, the effective rate of operation was 94.03%, 94.78%, 95.42%, 94.53%, and 95.12% (P < 0.05), the incidence rate of complication was 4.48%, 4.48%, 3.82%, 3.13%, and 1.63% (P < 0.05).

CONCLUSION: When the HFS was associated with the aVA, the effective rate of MVD was lower and the incidence of complication was higher than those associated with nVA. In MVD of HFS associated with aVA, the full decompression of the facial nerve and the minimal traction of surrounding tissue in the operation are the key to the success of MVD.