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Computed tomography (CT)-guided percutaneous stylomastoid foramen puncture radiofrequency ablation for the treatment of hemifacial spasm has a significant clinical effect; however, related risk factors for recurrence have not been studied. To investigate the risk factors for the recurrence of hemifacial spasm after radiofrequency ablation and construct a model for predicting recurrence. This is a single-center retrospective observational study. The study was conducted at the Pain Department of the Affiliated Hospital of Jiaxing College in Jiaxing, China. A retrospective analysis was performed on 99 patients diagnosed with primary hemifacial spasm (HFS) admitted to the Affiliated Hospital of Jiaxing University between August 2018 and December 2021. All patients underwent CT-guided percutaneous stylomastoid foramen radiofrequency ablation. Kaplan-Meier survival analysis, log-rank test, and Cox proportional risk regression model were used to analyze the clinical factors that affect the recurrence of patients with HFS after radiofrequency ablation, and a recurrence prediction model was established. Follow-up was 3-12 months; recurrence rates were 20.2%, 36.4%, and 71.9% at 3, 6, and 12 months postoperatively, respectively. Univariate analysis showed that puncture approach, operation time, and facial paralysis level were factors influencing recurrence in patients with HFS after radiofrequency ablation (P < 0.05). The multivariate Cox proportional risk regression model showed that the operative time and facial paralysis grade were independent factors for recurrence after radiofrequency ablation in patients with facial spasms. The recurrence risk function model of patients with facial spasms after radiofrequency ablation was expressed as h(t) = h0exp(-0.619X1-2.589X2), where X1 and X2 represent the operation time and facial paralysis grade, respectively. The likelihood ratio of the model was statistically significant (chi squared = 55.769, P < 0.001). We look forward to increasing the sample size in follow-up studies and exploring relevant conclusions in randomized controlled trials. Long operation times and high-grade facial paralysis can reduce the risk of recurrence in patients with facial spasms. The constructed recurrence prediction model could serve as a reference for clinical diagnosis and treatment.

Objective This study aimed to investigate the effect of preoperative botulinum toxin (BTX) injection on intraoperative abnormal muscle response ( AMR) in patients with hemifacial spasm (HFS). Methods A total of 104 patients (32 men, 72 women) who underwent microvascular decompression (MVD) for HFS were included in this study. A total of 62 patients without and 42 patients with preoperative BTX treatments were assigned to group A and group B, respectively. AMR recordings were obtained from the orbicularis oculi and mentalis muscles by stimulation of the marginal mandibular branch and zygomatic branch of the facial nerve, respectively. The intraoperative AMR monitoring findings and therapeutic effects were compared between groups A and B. Results The rates of the patients with unavailable AMRs recorded from the orbicularis oculi muscles in group B (38.1%) were significantly higher than those in group A (14.5%, p  = 0.006). Moreover, in cases with over 4 times BTX injection, the recordings of AMR from the orbicularis oculi muscles were poorer than the cases with less BTX injection ( p  = 0.001). There were no significant differences in the rates of the patients with unavailable AMRs recorded from the mentalis muscles between the two groups. There were no significant differences in the surgical results obtained between the two groups. Conclusions Preoperative BTX injections should be less than 4 times to ensure effective AMR monitoring. MVD using AMR monitoring is useful for patients with HFS who were previously treated by BTX as well as those who were not treated.

Abstract BACKGROUND Microvascular decompression (MVD) is the most effective procedure for hemifacial spasm (HFS). MVD results from nonspecialized or low-volume institutes are not always reliable. Most studies on MVD for HFS are retrospective and single centered; to the best of our knowledge, no prospective, multicenter studies exist. OBJECTIVE To evaluate short- and long-term outcomes and complications in patients who underwent MVD for HFS in specialized Japanese institutions, in this multicenter, prospective, cohort study. METHODS Included patients had undergone MVD for HFS in study centers between April 2012 and March 2015. Patients’ postoperative grade of involuntary movements and complications were recorded postoperatively at 7 d (short-term) and at 1 (mid-term) and 3 (long-term) yr. RESULTS A total of 486 patients (150 men, 336 women; mean age 53.9 yr with 181 patients over 60 yr) were enrolled during the study period. Neuromonitoring was used in 96.3% of the cases. The complete cure rate of symptom relief, mortality rate, and complication rate at short-term follow-up were 70.6%, 0%, and 15%, respectively. The long-term follow-up was completed by 463 patients (95.3%); the complete cure rate of symptom relief and complication rate were 87.1% and 3.0%, respectively. CONCLUSION Our study revealed that under expert guidance and intraoperative neuromonitoring, the long-term curative effect rate of MVD for HFS is high, while complications are uncommon and usually transient. Our results indicate that MVD is an effective and safe treatment for patients with HFS, including elderly patients. Graphical Abstract Graphical Abstract

Abstract BACKGROUND Microvascular decompression (MVD) is the surgical treatment of choice for hemifacial spasm (HFS). During MVD, monitoring of the abnormal lateral spread response (LSR), an evoked response to facial nerve stimulation, has been traditionally used to monitor adequacy of cranial nerve (CN) VII decompression. OBJECTIVE To assess the utility of LSR monitoring in predicting spasm-free status after MVD postoperatively. METHODS We searched PubMed, Web of Science, and Embase for relevant publications. We included studies reporting on intraoperative LSR monitoring during MVD for HFS and spasm-free status following the procedure. Sensitivity of LSR, specificity, diagnostic odds ratio, and positive predictive value were calculated. RESULTS From 148 studies, 26 studies with 7479 patients were ultimately included in this meta-analysis. The final intraoperative LSR status predicted the clinical outcome of MVD with the following specificities and sensitivities: 89% (0.83- 0.93) and 40% (0.30- 0.51) at discharge, 90% (0.84-0.94) and 41% (0.29-0.53) at 3 mo, 89% (0.83-0.93) and 40% (0.30-0.51) at 1 yr. When LSR persisted after MVD, the probability (95% CI) for HFS persistence was 47.8% (0.33-0.63) at discharge, 40.8% (0.23-0.61) at 3 mo, and 24.4% (0.13-0.41) at 1 yr. However, when LSR resolved, the probability for HFS persistence was 7.3% at discharge, 4.2% at 3 mo, and 4.0% at 1 yr. CONCLUSION Intraoperative LSR monitoring has high specificity but modest sensitivity in predicting the spasm-free status following MVD. Persistence of LSR carries high risk for immediate and long-term facial spasm persistence. Therefore, adequacy of decompression should be thoroughly investigated before closing in cases where intraoperative LSR persists. Graphical Abstract Graphical Abstract

Purpose Prognostic significance of lateral spreads response (LSR) disappearance in microvascular decompression (MVD) for hemifacial spasm (HFS) remains controversial. Still the timing of LSR disappearance and its association with overall outcomes has not been sufficiently investigated. We evaluate the prognostic significance of the timing of LSR disappearance during MVD in HFS. Methods Prospective documentation of the LSR-Status during the procedural steps was performed alongside routinely collected data. Surgical steps were categorized into three phases: Opening phase (skin incision till cisternal opening), arachnoid dissection, and actual Decompression phase. Outcome assessment was conducted after a follow-up period of at least 12 months, with favorable outcome defined as at least 90% resolution of the spasms. Results 214 patients were included with a mean age (SD) of 54.9 ± 11.6 years and a follow-up duration (SD) of 25.8 ± 15.7 months. The male-to-female ratio was 1:1.6. LSR was \"not detected\" in 32 patients (15.0%), with a 93.8% favorable outcome. LSR \"persisted\" in 22 patients (10.3%), showing only 77.3% favorable outcome. In 16 patients (7.4%), LSR disappeared during the opening phase, yielding a 100% favorable outcome. LSR disappearance occurred during arachnoid dissection in 40 patients (18.7%), with a 91.1% favorable outcome. Finally, LSR disappearance following nerve decompression was observed in 104 patients (48.6%), showing a 78.9% favorable outcome. Earlier disappearance of the LSR was associated with long-term cure (P-value < 0.05). Conclusion LSR may serve as a valuable intraoperative indicator during MVD for HFS. Early intraoperative disappearance of the LSR may predict favorable long-term outcomes. However, the disappearance of the LSR in general does not consistently correlate with surgical success.

Background Concurrent ipsilateral trigeminal neuralgia (TN) and hemifacial spasm (HFS) are rare and typically caused by dolichoectatic vertebrobasilar compression. Method A 59-year-old male with refractory TN and HFS underwent preoperative MRI revealing neurovascular conflict at the root entry zones. Simultaneous microvascular decompression (MVD) of the trigeminal and facial nerves was performed via a retrosigmoid craniotomy using Teflon padding. Conclusion The patient experienced immediate and sustained symptom resolution at the 18-month follow-up. Simultaneous MVD is effective for treating dual cranial nerve compression by dolichoectatic vessels.

Lennox-Gastaut syndrome (LGS) is a devastating and refractory generalized epilepsy affecting children and adolescents. In this study we report the results of resective surgery in 18 patients with LGS phenotype who underwent single-lobe/lesionectomy or multilobe resection plus multiple subpial transection and/or callosotomy. After surgery, seven patients became completely seizure-free (Engel Class I) and five almost seizure-free (Engel Class II). Additional four had significant seizure control (Engel Class III), and two had no change in seizure frequency (Engel Class IV). Of the 4 patients without any lesion on brain MRI, 2 ended with Engel Class II, 1 with III and the other with IV in Engels’ classification. Mean intelligence quotient (IQ) increased from 56.1 ± 8.1 (mean ± SD) before operation to 67.4 ± 8.2 (mean ± SD) after operation, a significant improvement (P=0.001). Results also indicated that the younger the patient at surgery, or the shorter the interval between onset of seizure and resective operation, the better the intellectual outcome. Our data suggest that resective epilepsy surgery can be successful in patients with LGS phenotype as long as the EEG shows dominance of discharges in one hemisphere and corresponding ipsilateral imaging findings, even with contralateral ictal discharges.

Background Following repeated botulinum toxin (BTX) treatments, patients with hemifacial spasm (HFS) are recommended to undergo microvascular decompression (MVD) for a permanent cure. Intraoperative lateral spread response (LSR) monitoring is important to improve surgical outcomes. However, LSR monitoring during MVD surgery in HFS patients who have previously received BTX is challenging, since the muscles typically used to assess the LSR are paralyzed. Here, we describe our use of the upper part of the orbicularis oculi and mentalis muscles for intraoperative monitoring of the LSR during MVD in HFS patients following BTX treatment. Methods HFS patients who underwent MVD surgery were divided into two groups based on their history of BTX treatment: BTX+ and BTX- groups. In the BTX+ group, MVD was performed at least 3 months after the last BTX injection. We measured LSR morphology, including the number of spikes, their duration, and maximum amplitude in all patients. We also measured intraoperative LSR disappearance rate, and the cure rate of HFS at the final follow-up (over 1 year after surgery). Results Although the waveforms showed a trend toward shorter durations with mandibular branch stimulation in the BTX+ group, there was no difference in the number of spikes or maximum amplitude values. There was no increase in LSR dysmetria after BTX treatment (BTX+ group: 32.8% vs. BTX- group: 31.9%). There was also no difference in intraoperative LSR disappearance rate between the two groups (BTX+ group: 68.3% vs. BTX- group: 74.6%). Conclusion Intraoperative LSR monitoring using the upper part of the orbicularis oculi muscle and the mentalis muscle at an interval of at least 3 months after the last BTX treatment might be a feasible monitoring technique during MVD for HFS.

Background Multiple vessels from the anterior inferior cerebellar artery–posterior inferior cerebellar artery common trunk (APC) variation of the posterior circulation can cause hemifacial spasm (HFS). Method Endoscopic microvascular decompression (eMVD) was performed using 0° and 30° endoscopes through a retrosigmoid keyhole. The root exit zone (REZ) was decompressed by transpositioning the offending anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) arising from the APC under excellent endoscopic view. Conclusion eMVD is an advanced, minimally invasive and reliable technique to resolve the neurovascular conflict (NVC) in HFS due to offenders from APC.

Background Microvascular decompression (MVD) represents the only definitive and non-ablative treatment for hemifacial spasm (HS). Teflon is the most used interposing material because considered inert; nevertheless, it is not free from complications. Method We discuss and illustrate our method to resolve the neurovascular conflict accounting for HS through a sling transposition technique using aneurysm clip and biopatch in carefully selected cases. Conclusion Several MVD procedures, including interposing and transposing techniques, have been proposed for HS, mainly selected according to surgeon’s preference. We consider the described technique a definitive treatment, safe, not associated to pain recurrence and without needing revision surgery.