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Updated: May 5, 2026
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Pontine Microtubular Signal Intensity in Hemifacial Spasm: Association with Outcome After Microvascular Decompression
Hyun Seok Lee1, Hong Gee Roh2, Won-Jin Moon2
1Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea.
Background:
We aimed to investigate the prevalence and clinical significance of pontine microtubular signal intensity (MSI), presumed dilated perivascular or perineural spaces, in patients with hemifacial spasm (HFS) using high-resolution MRI using proton density-weighted imaging (HR-PDI).
Methods:
We retrospectively analyzed 438 patients with unilateral HFS who underwent microvascular decompression (MVD) and preoperative HR-PDI. MSI was defined as a linear or curvilinear hyperintense lesion along the presumed course of the intraparenchymal facial nerve fascicles within the pons on HR-PDI. The presence and laterality of MSI were evaluated by consensus between two reviewers and classified according to their relationship to the symptomatic side of HFS as ipsilateral (same side as the facial spasm), contralateral (opposite side), or bilateral. Clinical characteristics, surgical findings, and postoperative outcomes were compared according to the presence of ipsilateral MSI. A control group of 307 subjects who underwent HR-PDI for non-central neurologic symptoms was included to assess the prevalence of MSI. Multivariable logistic regression analysis was performed to identify factors associated with immediate postoperative improvement after MVD.
Results:
MSI was more frequently observed in patients with HFS than in controls after adjusting age and sex (OR, 3.78; 95% CI, 2.747-5.197; p < 0.001). Ipsilateral MSI was identified in 267 of 438 patients (61.0%). Patients with ipsilateral MSI showed a significantly higher frequency of contralateral MSI (p < 0.001) and vertebralartery-related compression (p = 0.002). Immediate postoperative improvement after MVD was less frequent in patients with ipsilateral MSI than in those without MSI (77.5% vs. 86.5%, p = 0.019). Multivariable logistic regression analysis demonstrated that ipsilateral MSI was independently associated with a lower likelihood of immediate postoperative improvement (OR, 0.411; 95% CI, 0.222-0.759; p = 0.005). However, long-term surgical outcomes were not significantly different according to the presence of MSI.
Conclusions:
Pontine MSI on HR-PDI is more frequently observed in patients with HFS and is associated with a lower likelihood of immediate postoperative improvement and a tendency toward delayed recovery after MVD but not with poorer long-term outcomes. These findings suggest that MSI may represent microstructural or neurofluidic alterations along the pontine facial nerve pathway and may serve as an imaging marker of delayed recovery dynamics.
Insights
Pontine microtubular signal intensity (MSI) is more common in hemifacial spasm (HFS) patients and indicates a higher chance of delayed recovery after microvascular decompression (MVD). However, long-term outcomes remain unaffected by MSI presence.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Investigating pontine microtubular signal intensity (MSI), potentially dilated perivascular or perineural spaces.
- Utilizing high-resolution proton density-weighted imaging (HR-PDI) for assessment in hemifacial spasm (HFS) patients.
Purpose of the Study:
- To determine the prevalence and clinical significance of pontine MSI in HFS patients.
- To evaluate the association between MSI and outcomes following microvascular decompression (MVD).
Main Methods:
- Retrospective analysis of 438 HFS patients undergoing MVD and preoperative HR-PDI.
- Defining MSI as hyperintense lesions along the pontine facial nerve fascicles.
- Comparing outcomes based on MSI presence and laterality, with a control group of 307 subjects.
Main Results:
- MSI was more frequent in HFS patients (61.0% ipsilateral) than controls (OR, 3.78).
- Ipsilateral MSI correlated with contralateral MSI and vertebral artery compression.
- Immediate postoperative improvement after MVD was less frequent in patients with ipsilateral MSI (77.5% vs. 86.5%), independently associated with lower improvement likelihood (OR, 0.411).
Conclusions:
- Pontine MSI on HR-PDI is more prevalent in HFS patients.
- MSI is linked to reduced immediate postoperative improvement and delayed recovery after MVD.
- MSI may indicate microstructural changes and serve as a marker for delayed recovery, without affecting long-term outcomes.
