Hemifacial spasm: 20-year surgical experience, lesson learned.

Area of Science:

• Neurosurgery
• Neurology

Background:

• Hemifacial spasm involves involuntary, unilateral facial contractions, predominantly affecting women on the left side.
• The condition is progressive and rarely resolves without intervention.

Purpose of the Study:

• To evaluate the efficacy and outcomes of microvascular decompression for hemifacial spasm in a large Hispanic patient cohort.
• To identify factors influencing treatment response and surgical success.

Main Methods:

• Retrospective analysis of 226 microvascular decompressions performed on 194 Hispanic patients between May 1992 and May 2011.
• Outcomes were assessed using a 4-point scale: excellent, good, bad, and recurrence.
• Vascular compression identified during surgery, with specific arteries noted.

Main Results:

• Excellent outcomes (complete remission) were achieved in 79.9% of patients.
• The anterior inferior cerebellar artery was the most frequent cause of compression (n=147).
• Recurrence occurred in 10.8% of patients at a mean follow-up of 51 months; transient hearing loss and facial palsy were noted complications.

Conclusions:

• Microvascular decompression is the preferred, minimally invasive treatment for hemifacial spasm, yielding excellent long-term results with low morbidity.
• Early reoperation is warranted if no improvement is seen within one week post-surgery.
• Patient sex, side affected, and age at onset did not correlate with treatment response.