Introduction: Hemifacial spasm characterized by involuntary paroxistic contractions of the face is more frequent on left side and in females. Evolution is progressive and in a few cases may disappear. Management includes medical treatment, botulinum toxin
and microvascular decompression of the nerve.
Methods: We present the results of 224 microvascular decompressions performed by one surgeon in 194 patients over 20 years from may 1992 to may 2011.
Results: Most of the patients had previous medical treatment. All patients were operated on with microsurgical technique by asterional craniotomy. Vascular compression was present in most of the cases. Follow-up was from 1 to 120 months. Gender: 63% female, 37% male. Age average 50.2 years. Starting age: 44.6 years. Time before surgery: 6.6 years. Side: 58.5% left, 41.5% right. Start: Typical 90.7%. Offending Vessel: None: 9, SUCA: 8, AICA: 148, PICA: 12, Basilar: 10, 2 vessels: 8. Excellent results after first surgery 82%, good results in 17.5% and 1 death. 27 patients requiered a second surgery with excellent results in 88.8%, 3 patients requiered a thrid exploration with cessation of the spams in all of them. Hipoacusia and transitory facial palsy were the most common complications in 9% of the patients. Long term results were excellent in 84.2% with cessation of the spasm, improvement in 15.3% and 1 death.
Conclusions: Hemifacial spasm is a painless but disabling entity. Medical treatment is effective in a limited fashion. Injection of botulinum toxin has good response but benefit is transitory. Microvascular decompression is treatment of choice because it is minimally invasive, not destructive, requires minimum technical support, and yields best long-term results with less complications.
Patient Care: There are many treatments for hemifacial spasm, but some of them just provide transitory benefits, and the surgery is a save option with long term results and less complications.
Learning Objectives: By the conclusion of this session, participants should known that microvascular decompression is a save and efficient treatment for hemifacial spasm, with great results and less morbility.
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