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Repeat microvascular decompression for hemifacial spasm
  1. J A Engh,
  2. M Horowitz,
  3. L Burkhart,
  4. Y-F Chang,
  5. A Kassam
  1. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  1. Correspondence to:
 Dr Amin Kassam
 University of Pittsburgh Medical Center, Center for Cranial Nerve Disorders, Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA;


Objective: To report our experience with repeat microvascular decompression (MVD) for hemifacial spasm (HFS) in patients who have failed their first operation.

Methods: The authors describe 41 redo MVDs for HFS in 36 patients performed over a 3 year period. Seven patients underwent early re-operation after an aborted seventh nerve decompression. Eight patients underwent early re-operation for clinical failure. Eighteen patients underwent late re-operation for spasm recurrence long after their original MVD. Eight MVDs were performed on patients who had already undergone at least two prior operations.

Results: Twenty four patients experienced complete spasm resolution (70.6%), eight patients had near total resolution (23.5%), and two patients failed re-operation (5.9%). Two patients were lost to follow up (5.6%). A favourable outcome was reported by 82.4% of patients at a mean follow up interval of 18 months. A total of 91.7% of patients 50 years of age or younger were cured at follow up versus 59.1% of patients older than 50 (p = 0.04). Patients undergoing early re-operation were significantly more likely to be cured or improved than patients undergoing late re-operation (p = 0.03).

Conclusions: Repeat MVD for HFS is effective in experienced hands. Younger patients respond better to repeat MVD. Late repeat MVD for HFS is a reasonable treatment option, although results are less favourable than for early re-operation.

  • AICA, anterior inferior cerebellar artery
  • EMG, electromyography
  • HBS, House-Brackmann score
  • HFS, hemifacial spasm
  • MVD, microvascular decompression
  • PICA, posterior inferior cerebellar artery
  • SAT, speech awareness threshold
  • UPMC, University of Pittsburgh Medical Center
  • decompression
  • hemifacial
  • microvascular
  • spasm

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  • Competing interests: none declared