[Further comment on surgical approach for hemifacial spasm]

A new surgical approach for the treatment of hemifacial spasm was carried out in 110 cases from 1991-1994. The novelty of this new procedure lies in splitting of facial nerve by making multiple cuts along the long axis of the nerve--descriptively a type of "combing". Among these cases, arachnoid thickening and adhesion occurred in 35 cases throughout the vascular course, 66 cases showed vascular compression (60%). A segment of vessel could be seen lying between VII and VIII cranial nerves in 16 cases. Under the latter circumstance steps taken for decompression would be either too risky or impossible. Postoperatively all cases got marked improvement or total disappearance of symptoms & signs. Follow up varying 1-4 years showed recurrence of symptoms in 6 cases (5.4%). This was explaned in light of insufficient splitting. It might be due to lack of experience or on account of vascular enclosures. It was suggested that at least 20 cuts should be made and tested with a minimum of 10mA electric stimulation to achieve good result.