caa a22 4500 606213414 CHVBK 20210128101047.0 cr unu---uuuuu 210128e20150101xx s 000 0 eng 10.1007/s00701-014-2247-x doi (NATIONALLICENCE)springer-10.1007/s00701-014-2247-x Delayed relief of hemifacial spasm after microvascular decompression: can it be avoided? [Elektronische Daten] [Jun Zhong, Lei Xia, Ning-Ning Dou, Ting-Ting Ying, Jin Zhu, Ming-Xing Liu, Shi-Ting Li] Background: Although microvascular decompression (MVD) surgery has been widely accepted as an effective treatment for hemifacial spasm (HFS), delayed relief cases have been frequently reported. Therefore, the value of an immediate redo MVD should be discussed. Methods: This study included 1,435 HFS patients who underwent MVD with intraoperative abnormal muscle response (AMR) monitoring from 2011 through 2013 at XinHua Hospital. These cases were analyzed retrospectively with emphasis on the postoperative outcomes and introaperative findings. Results: After MVD, 1,384 HFS patients obtained relief immediately. The 51 unrelieved patients underwent AMR monitoring again the next day; this was positive in 48 and negative in 3 patients. These three patients with negative AMR obtained relief spontaneously within a week. Among the 48 positive patients, 31 and 11 were underwent redo MVD within a week and 5-22 months, respectively, and all achieved relief after the second operation. Of the six remainig patients, two obtained relief within 2months and 4 remained unchanged in the up-to-3-year's follow-up period. In redo MVDs, insufficient decompression of the facial nerve accounted for the failure. Finally, in this database, the immediate postoperative cure rate was 96.4%; with earlier redo MVD, the final cure rate could be increased to 99.9%. Conclusions: Despite being a reasonable remedy for HFS in the hands of an experienced neurosurgeon, sometimes small vessels can be missed while managing the main offending arteries during MVDs, which might account for the delayed relief. Therefore, reexamination of the AMR is necessary for unimproved patients; if a positive result is recorded, an immediate redo MVD is suggested. Springer-Verlag Wien, 2014 Microvascular decompression nationallicence Hemifacial spasm nationallicence Delayed relief nationallicence Reoperation nationallicence Offending artery nationallicence Zhong Jun Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut Xia Lei Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut Dou Ning-Ning Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut Ying Ting-Ting Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut Zhu Jin Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut Liu Ming-Xing Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut Li Shi-Ting Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut Acta Neurochirurgica Springer Vienna 157/1(2015-01-01), 93-99 0001-6268 157:1<93 2015 157 701 https://doi.org/10.1007/s00701-014-2247-x text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-014-2247-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Zhong Jun Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut NATIONALLICENCE 700 1- Xia Lei Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut NATIONALLICENCE 700 1- Dou Ning-Ning Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut NATIONALLICENCE 700 1- Ying Ting-Ting Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut NATIONALLICENCE 700 1- Zhu Jin Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut NATIONALLICENCE 700 1- Liu Ming-Xing Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut NATIONALLICENCE 700 1- Li Shi-Ting Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/1(2015-01-01), 93-99 0001-6268 157:1<93 2015 157 701