Introduction: To identify risk factors for recurrent hemifacial spasm (HFS) after the initial microvascular decompression (MVD) and assess the feasibility of redo MVD
Methods: The study included 16 consecutive patients who were performed redo MVD during the last two decades. Their medical charts were retrospectively reviewed for preoperative medical history, initial and redo MVD intraoperative findings, and initial and redo MVD postoperative outcome.
Results: Median interval between initial and redo MVD was 34.8 months. Vein offender, perforator compression type, and compression location medial to or cisternal segment of facial nerve were found to be risk factors for initial MVD failure. 88% of patients showed disappearance of abnormal muscle response after decompression intraoperatively. BAEP change was monitored during surgery in 37.5%. During median follow-up of 7.2 months, final responder after redo MVD was 75%. Hearing impairment and facial palsy were observed in 3 and 3 (18.8%) patients, respectively. One cerebellar infarction due to cortical branch of PICA injury during dura opening was witnessed without significant symptom. There was no mortality.
Conclusions: Redo MVD is still a feasible treatment option for recurrent HFS patients. 360° and whole segment of facial nerve should be explored, especially focusing on medially located vein or arterial offender located at cisternal segment.
Patient Care: To know how to achieve a successful MVD as a neurosurgeon, patients can be free from recurrent HFS and avoid revisional surgery.
Learning Objectives: Identify risk factors for MVD failure and know what to achieve during MVD.