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Outcomes of Microvascular Decompression for Hemifacial Spasm at the Philippine General Hospital
Gerardo D Legaspi1, Lady Scarlette P Sedano1, Juan Silvestre G Pascual1
1Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila.
Insights
Microvascular decompression (MVD) for hemifacial spasm (HFS) is effective in Filipino patients, showing an 88.2% success rate. Improving referral systems can enhance patient access to this viable treatment option.
Area of Science:
- Neurosurgery
- Neurology
- Surgical Outcomes
Background:
- Hemifacial spasm (HFS) is a neurological disorder characterized by involuntary facial muscle contractions.
- Microvascular decompression (MVD) is a surgical procedure to treat HFS by relieving pressure on the facial nerve.
Purpose of the Study:
- To evaluate the demographics, clinical characteristics, and surgical outcomes of MVD for HFS at Philippine General Hospital (PGH).
- To assess the success rate and complications associated with MVD in a Filipino population.
Main Methods:
- Retrospective review of 34 MVD operations for primary HFS performed between January 2018 and December 2022.
- Analysis of demographic data, intra-operative findings, outcomes, and complications.
Main Results:
- An overall success rate of 88.2% was achieved, with a median follow-up of 15 months.
- Significant reduction in HFS grades post-surgery compared to pre-operative grades.
- Common complications included transient facial nerve palsy (29.4%) and hearing loss (17.6%).
- Factors like years before surgery and pre-operative pharmacologic treatment increased HFS grade, while hypertension decreased it.
Conclusions:
- MVD is a viable and effective treatment for Filipino patients with HFS, demonstrating success rates comparable to international studies.
- Enhancing surgical techniques and referral systems can improve accessibility to MVD surgery.
Objective:
To report the demographics, clinical characteristics, and surgical outcomes after microvascular decompression (MVD) for hemifacial spasm (HFS) in the Philippine General Hospital (PGH).
Methods:
Between January 2018 to December 2022, the division of Neurosurgery at PGH performed thirty-four MVD operations for Primary HFS. Records were retrospectively reviewed, and pertinent demographic, intra-operative findings, outcomes, and complications were analyzed.
Results:
The overall success rate is 88.2%, with a median follow-up at 15 months. Repeated measures ANOVA showed that post-op HFS and follow-up HFS grades were significantly lower than pre-op HFS grades (F=17.46, df=33, p<0.0001). HFS average age of symptom onset was early at 38.5 years, 11.8% of which were <30y/o. The M: F ratio was 1:2.4. Thirty out of 34 patients came for MVD surgery as referrals from a social media support group. Ordered logistic regression showed that years before surgery (OR:7.05, z=2.23, p=0.026) and pre-operative pharmacologic treatment (OR:48, z=2.33, p=0.02) increase the HFS grade to the next worse grade. At the same time, hypertension (OR: 0.006, z=-2.54, p=0.011) decreases pre-operative HFS grade to a lower degree. Post-operative complications were facial nerve palsy (29.4% transient and 5.9% permanent), hearing loss (17.6% transient and 5.9% permanent), CSF leak/infection (2.9%), and recurrence (8.8%).
Conclusion:
MVD at PGH is a viable choice treatment option for Filipino patients with success rates comparable to internationally published studies. Besides improving surgical technique, improvement of referral systems may help make surgery more accessible.
