Delayed facial palsy after microvascular decompression for hemifacial spasm: friend or foe?

Abstract

OBJECTIVE The authors investigated the incidence, clinical course, and predisposing factors associated with delayed facial palsy (DFP) following microvascular decompression (MVD). METHODS The authors reviewed the records of 310 patients (311 cases) who were followed after MVD for hemifacial spasm (HFS). Of these patients, 45 (14.5%) developed DFP after MVD. The clinical characteristics and predisposing factors of the patients with HFS were investigated to identify prognostic factors that predicted the development of DFP after MVD. Log-rank tests were used to compare times to symptom disappearance, and a logistic regression analysis was performed to compare clinical characteristics between patients who developed DFP and those who did not. RESULTS HFS was completely resolved immediately after MVD in 158 cases (50.8%), and HFS eventually disappeared in 289 (92.9%) of the cases. Of the 45 patients with DFP, 17 were men and 28 were women. DFP occurred between postoperative Days 1 and 44 (mean 9.67 days). Finally, 44 patients (97.8%) completely recovered. The average time to recovery was 3.9 months (range 1-24 months). Patients who had experienced an immediate disappearance of HFS experienced a significantly higher occurrence of DFP than those who did not (odds ratio 0.383, 95% confidence interval 0.183-0.802; p = 0.011). In addition, preoperative botulinum neurotoxin injections negatively influenced the occurrence of DFP (p = 0.016). CONCLUSIONS In this study, the incidence rate of DFP was slightly higher than previously reported values. Moreover, DFP can occur even when spasms disappear immediately after MVD, but the patients with DFP can fully recover within weeks.

Keywords: CI = confidence interval; CISS = constructive interference in steady state; DFP = delayed facial palsy; HB = House-Brackmann; HFS = hemifacial spasm; LSR = lateral spread response; MVD = microvascular decompression; OR = odds ratio; PTA = pure tone audiometry; REZ = root entry zone; SDA = speech discrimination audiometry; SNUH = Seoul National University Hospital; VA = vertebral artery; delayed facial palsy; fEMG = facial electromyography; functional neurosurgery; hemifacial spasm; microvascular decompression.