Facial root entry/exit zone contact in microvascular decompression for hemifacial spasm: a historical control study

Area of Science:

• Neurosurgery
• Neurology

Background:

• Microvascular decompression (MVD) is effective for hemifacial spasm (HFS).
• MVD involves implanting biocompatible materials at the neurovascular conflict site, either contacting or not contacting the facial root entry/exit zone (REZ).
• The comparative efficacy of REZ-contact versus REZ-non-contact procedures is not well-established.

Purpose of the Study:

• To investigate the impact of REZ-contact versus REZ-non-contact implant placement on MVD surgical operations and outcomes for HFS.
• To compare early and long-term postoperative results, including cure rates and complications.

Main Methods:

• A historical control study reviewed MVD cases between December 2016 and November 2018.
• Patients were categorized into REZ-contact or REZ-non-contact groups based on surgical strategy.
• Clinical demographics, outcomes, and complications were collected and compared.

Main Results:

• The REZ-non-contact group had a significantly higher early complete cure rate and lower incidence of short-term neurological complications (e.g., hearing loss, facial palsy).
• The REZ-contact group showed higher rates of symptom reappearance and partial relief.
• Long-term follow-up (>1 year) revealed no significant differences in curative effects or complications between the groups. REZ-non-contact procedures had longer operating times and one case of subdural hemorrhage.

Conclusions:

• REZ-non-contact decompression offers superior short-term outcomes in MVD for HFS.
• However, due to limitations and potential risks, it serves as an alternative individualized strategy, not a universally required approach.
• There is no imperative to exclusively pursue REZ-non-contact during MVD surgery.