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[Microsurgical vascular decompression in the treatment of facial hemispasm. A retrospective study of a series of 65 cases and review of the literature].

The results of a series of 65 consecutive patients operated on to relieve hemifacial spasm (HFS) at Pierre Wertheimer Hospital in Lyon and at Henri Mondor Hospital in Creteil, using the same microvascular decompression (MVD) method, are reported. MDV was performed through a retromastoid keyhole approach. A neurovascular conflict (NVC) was found in 62 cases (i.e., 95.5%). The conflicting vessel was the posterior inferior cerebellar artery (PICA) in 23 cases (35.4%), the anterior inferior cerebellar artery (AICA) in 22 cases (33.8%), the vertebro-basilar artery (VBA) with PICA and/or AICA in 13 cases (20%), and VBA alone in 4 cases (3.1%). The conflicting artery was maintained apart from the REZ of VII nerve by interposing a ball made of Teflon fibers and/or a plaque of Dacron. Forty-five patients (69.2%) were totally cured, 16 patients (24.6%) had only a partial (more than 50%) improvement, and in 4 patients (6.2%) surgery failed. Follow-up ranged from 1 month to 13 years (mean: 4 years and 8 months). Important was that in 9 patients, total relief of spasm occurred only secondarily with a delay sometimes as long as one year. Post-operative complications were dominated by: 1) facial nerve deficits in 16 cases (24.6%), of which 14 were transient and 2 were permanent; 2) hearing decrease in 10 cases (15.4%), of which 5 were transient and 5 were permanent. These complications were encountered at the start of the experience and at a time when monitoring of intraoperative brainstem auditory evoked potentials (BAEP) was not routinely done. Our data proved to be consistent with those published in the literature.