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Nadia Bouamama, Jacky Vidal, Pierre-Yves Robert, Jean-Jacques Gicquel, Michèle Boissonnot, Jean-Paul Adenis, Paul Dighiero; Treatment Of Hemifacial Spasm With Microvascular Decompression Of Gardner-jannetta : A Report Of 43 Cases. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3901.
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Hemifacial spasm is a rare pathology characterized by an evident symptomatology and caused by vascular compression of the facial nerve. Its treatment is double: symptomatic with botulinum toxin and etiologic with the neurovascular decompression codified by Gardner and Jannetta. In this study, we report our long-term results for 43 cases treated with this procedure.
The results of 43 decompressions to treat hemifacial spasm (performed between 1989 and 2009) among 43 patients (48.8% female patients and 51.2% male patients ; mean age, 53.8 yr) are presented. Before the introduction of magnetic resonance imaging highlighting the vascular features around the root entry zone, computed tomography was the only radiological method used. Before surgery, 76.7% of our patients had injections of botulinum toxin. Six patients were lost to follow-up monitoring and 37 are still undergoing follow-up monitoring, with an average period of 34.4 months.
The anteroinferior cerebellar artery was involved in 17 out of 36 patients, (47.2%). In 30.5% of cases, there existed multiple areas of compression on the nerve attributable to different vessels. 83.8% of our patients were spasm-free or had few spasms. Deafness was the main postoperative complication (13.5%). In the postoperative phase, 10.8% of our patients needed botulinum toxin. Most of the patients (90%) had been referred to neurosurgeons by ophthalmologists.
Statistical analysis has not established as a prognosis factor for recovery the duration of symptoms or preoperative botulinum toxin. Analysis of our series demonstrates that microvascular decompression is a definitive treatment in more than 80% of cases. It is particularly important for ophthalmologists to be informed on treatments for hemifacial spasm because they are often on the first line.
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