Factors Promoting a Good Outcome in a Second Microvascular Decompression Operation When Hemifacial Spasm is Not Relieved After the Initial Operation
| Autor: | Ting-Ting Ying, Xin Zhang, Jin Zhu, Yuan Yan, Shiting Li, Yinda Tang, Hua Zhao |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Muscle response Microvascular decompression 03 medical and health sciences 0302 clinical medicine medicine.artery medicine Humans Hemifacial Spasm Good outcome Aged medicine.diagnostic_test Electromyography business.industry Magnetic resonance imaging Middle Aged medicine.disease Magnetic Resonance Imaging digestive system diseases Microvascular Decompression Surgery Surgery Anterior inferior cerebellar artery Treatment Outcome 030220 oncology & carcinogenesis Anesthesia cardiovascular system Female Neurology (clinical) business 030217 neurology & neurosurgery Follow-Up Studies Hemifacial spasm |
| Zdroj: | World Neurosurgery. 98:872.e11-872.e19 |
| ISSN: | 1878-8750 |
| Popis: | Background Microvascular decompression (MVD) has become the best treatment for hemifacial spasm (HFS); however, some patients do not obtain complete relief after the initial MVD. We analyzed a group of patients who underwent a second MVD, to identify the factors that prevented relief after the initial MVD and those that promote the success of the second procedure. Methods Of a group of 1400 patients with typical primary unilateral HFS treated with MVD between January 2014 and October 2015, we focused on 42 patients with poor postoperative outcomes. All patients underwent abnormal muscle response (AMR) monitoring again the day after surgery. Of those patients, 35 underwent a second MVD surgery within a week. We analyzed their AMRs after each operation. Results After the first operation, AMR was positive in 40 patients and negative in 2 patients. The latter 2 patients reported spontaneous relief within 1 week. Among the 40 positive patients, 35 and 4 patients underwent a second MVD within a week and 6–11 months, respectively. Thirty-nine patients reported relief after the second MVD; 1 patient remained unchanged at follow-up ( Conclusions When initial MVD does not provide relief, a repeat MVD should be performed as soon as possible. In 2/42 cases, relief was delayed enough that AMR had a false-negative result. Combinative monitoring of AMR and Z-L responses was important in identifying the real cause of HFS. |
| Databáze: | OpenAIRE |
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