Fully endoscopic microvascular decompression for hemifacial spasm: a systematic review

Hemifacial spasm (HFS) is a distressing condition caused by facial nerve compression and characterized by involuntary facial muscle twitching, adversely impacting quality of life. Microvascular decompression (MVD) is effective but poses risks. Fully endoscopic MVD (E-MVD) as an emerging technique offers enhanced safety and efficacy. Therefore, this systematic review aimed to evaluate the use of fully E-MVD in treating HFS. In accordance with PRISMA guidelines, the systematic review included a thorough literature search in PubMed/MEDLINE, Embase, and Cochrane Library. Eligible studies were evaluated based on predefined criteria, with duplicates eliminated and conflicts resolved by a senior author. Data extraction was performed independently by two authors, with disagreements resolved by the senior author. Details on study characteristics, demographics, intraoperative observations, postoperative complications, and efficacy of fully E-MVD for HFS were gathered. Quality assessment was conducted using the NIH tool. A total of 408 patients were included in the study, with females comprising 68% and males 32% of the cohort. The mean age of patients was 52.4 years, with an average symptom duration of 4.5 years. Right-sided and left-sided symptoms were reported in 54.4% and 46.6% of patients, respectively. Intraoperatively, the most common offending blood vessel was a single AICA (48.1%). Early postoperative complications were reported in 13.6% of patients, which primarily consisted of transient facial palsy (6.8%) and hearing impairment (4%). All cases of facial palsy resolved during the follow-up period, yet 1.3% of hearing impairments persisted. The efficacy of Fully E-MVD for HFS was promising, with 93.3% of patients experiencing effective resolution at follow-up. With advancements in surgical techniques and technology, fully E-MVD continues to show promising results in improving the quality of life for patients suffering from HFS. Favorable outcomes and symptom resolution support fully E-MVD's advantages. Surgeons must consider limitations and proper techniques for optimal patient outcomes.