Complications of microvascular decompression in hemifacial spasm treatment - Retrospective analysis of 156 cases

BACKGROUND: Microvascular decompression has become a well-accepted, safe method in the treatment of hemifacial spasms. However, postoperative complications exist and influence the prognosis of the disease. OBJECTIVE: This study aimed to analyze, by case review, the characteristics and regularity of microvascular decompression complications in the treatment of hemifacial spasm. DESIGN: Retrospective analysis. SETTING: Beijing General Group Hospital of the Chinese People's Armed Police Forces. PARTICIPANTS: A total of 156 patients with hemifacial spasm were admitted to the Department of Neurosurgery. Beijing General Group Hospital of the Chinese People's Armed Police Forces from June 2004 to June 2006 and recruited for this study. The patients, 57 males and 99 females, averaged 46 years of age (range 17-68-years old). All Suffered from facial innervated muscular paroxysmal and recurrent contraction, which could not be controlled by consciousness. Electromyogram demonstrated waves of fibrillation and fasciculation. Prior to admission, all patients had received other treatments. Written informed consents for treatment were obtained from all patients. This protocol was approved by the Hospital's Ethics Committee. METHODS: After anesthesia. a cranial bone pore was drilled below the connection of the lateral sinus and sigmoid sinus. Dura mater was dissected at the "perpendicular to" shape and held in the air. Under microscopy, the flocculus cerebelli was lifted slightly up for convenient observation of the cerebellopontine angle. The mucous membrane was,as sharply separated. Corresponding vessels were identified at the root of the facial nerves and subsequently liberated and disassociated from the root exit zone. Suitably sized Teflon cotton was placed between the corresponding vessels and brain stem. MAIN OUTCOME MEASURES: Complications of microvascular decompression. RESULTS: All 156 patients participated in the final analysis. (1) Postoperatively, 66 (42%) patients presented with obvious headache or dizziness, 5 (3%) with severe headache, 43 (28%) with nausea or vomiting for 12 hours to 3 days. and 19 (12%) with aseptic meningitis and a body temperature of 37.5-40 degrees C. Patients. who suffered from headache and fever, were cured after 2-5 lumbar punctures. (2) Postoperatively, 19 (8%) patients suffered from, short-term dysaudia and tinnitus on the affected side, 9 (6%) from mild hemifacial spasms, and 2 (1%) from ambiopia. All patients were cured after treatment with a neurotrophic drug. (3) Postoperatively, 4 (2%) patients suffered from cerebrospinal fluid incision leakage and 2 (1%) from cerebrospinal rhinorrhea. The cerebrospinal fluid incision was tightly sutured. One case of cerebrospinal rhinorrhea was cured after mastoid process repair, and the other one recovered spontaneously. CONCLUSION: Experimental results have indicated that low intracranial pressure is the main complication of microvascular decompression in patients with hemifacial spasms, and no permanent neuro-functional impairment was found.