J Korean Neurosurg Soc.  2012 Oct;52(4):288-292. 10.3340/jkns.2012.52.4.288.

Delayed Cranial Nerve Palsy after Microvascular Decompression for Hemifacial Spasm

• Han JS
• Lee JA
• Kong DS
• Park K

• KMID: 2190642
• DOI: http://doi.org/10.3340/jkns.2012.52.4.288

Abstract

OBJECTIVE
Microvascular decompression (MVD) for hemifacial spasm (HFS) is a safe and effective treatment with favorable outcomes. The purpose of this study was to evaluate the incidence of delayed cranirve ( VI, VII, and VIII ) palsy following MVD and its clinical courses.
METHODS
Between January 1998 and December 2009, 1354 patients underwent MVD for HFS at our institution. Of them, 100 patients (7.4%) experienced delayed facial palsy (DFP), one developed sixth nerve palsy, and one patient had delayed hearing loss.
RESULTS
DFP occurred between postoperative day number 2 and 23 (average 11 days). Ninety-two patients (92%) completely recovered; however, House-Brackmann grade II facial weakness remained in eight other patients (8%). The time to recovery averaged 64 days (range, 16 days to 9 months). Delayed isolated sixth nerve palsy recovered spontaneously without any medical or surgical treatment after 8 weeks, while delayed hearing loss did not improve.
CONCLUSION
Delayed cranial nerve (VI, VII, and VIII) palsies can occur following uncomplicated MVD for HFS. DFP is not an unusual complication after MVD, and prognosis is fairly good. Delayed sixth nerve palsy and delayed hearing loss are extremely rare complications after MVD for HFS. We should consider the possibility of development of these complications during the follow up for MVD.

Keyword

Delayed facial palsy; Microvascular decompression; Delayed cranial palsy; Delayed hearing loss; Delayed abducens palsy

MeSH Terms

Abducens Nerve Diseases
Cranial Nerve Diseases
Cranial Nerves
Facial Paralysis
Follow-Up Studies
Hearing
Hearing Loss
Hemifacial Spasm
Humans
Incidence
Isoflurophate
Microvascular Decompression Surgery
Paralysis
Prognosis
Isoflurophate

Figure

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  Fig. 1 The onset time for delayed facial palsy averaged 11.2 days with a range between 2 to 23 days. DFP : delayed facial palsy.

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  Fig. 2 The time to recovery averaged 64.1 days (range : 16-270 days). DFP : delayed facial palsy.

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  Fig. 3 Three weeks after MVD, PTA-SA shows scale-out on the operated side. MVD : microvascular decompression, PTA-SA : pure tone audiometry and speech discrimination.

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  Fig. 4 One month after onset, PTA-SA shows ipsilateral hearing function improved. PTA-SA : pure tone audiometry and speech discrimination.

Reference

1. Auger RG, Whisnant JP. Hemifacial spasm in Rochester and Olmsted County, Minnesota, 1960 to 1984. Arch Neurol. 1990; 47:1233–1234. PMID: 2241620.

2. Berlit P. Isolated and combined pareses of cranial nerves III, IV and VI. A retrospective study of 412 patients. J Neurol Sci. 1991; 103:10–15. PMID: 1865222.

3. Dallan I, De Vito A, Fattori B, Casani AP, Panicucci E, Berrettini S, et al. Intratympanic methylprednisolone in refractory sudden hearing loss : a 27-patient case series with univariate and multivariate analysis. Otol Neurotol. 2010; 31:25–30. PMID: 19940792.

4. De Ridder D, Menovsky T. Neurovascular compression of the abducent nerve causing abducent palsy treated by microvascular decompression. Case report. J Neurosurg. 2007; 107:1231–1234. PMID: 18077964.

5. Franco-Vidal V, Nguyen DQ, Guerin J, Darrouzet V. Delayed facial paralysis after vestibular schwannoma surgery : role of herpes viruses reactivation--our experience in eight cases. Otol Neurotol. 2004; 25:805–810. PMID: 15354015.

6. Furukawa K, Sakoh M, Kumon Y, Teraoka M, Ohta S, Ohue S, et al. [Delayed facial palsy after microvascular decompression for hemifacial spasm due to reactivation of varicella-zoster virus]. No Shinkei Geka. 2003; 31:899–902. PMID: 12968493.

7. Hanakita J, Kondo A. Serious complications of microvascular decompression operations for trigeminal neuralgia and hemifacial spasm. Neurosurgery. 1988; 22:348–352. PMID: 3352885.

8. Hitotsumatsu T, Matsushima T, Inoue T. Microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia : three surgical approach variations : technical note. Neurosurgery. 2003; 53:1436–1441. discussion 1442-1443. PMID: 14633313.

9. Hyun SJ, Kong DS, Park K. Microvascular decompression for treating hemifacial spasm : lessons learned from a prospective study of 1,174 operations. Neurosurg Rev. 2010; 33:325–334. discussion 334. PMID: 20349099.

10. Kim BT, Hwang SC, Chang JC, Shin WH, Choi SK, Byun BJ. Delayed facial palsy following microvascular decompression in hemifacial spasm patients. J Korean Neurosurg Soc. 1999; 28:1332–1336.

11. Kim JW, Park K. Transient six nerve paresis with the delayed onset after microvascular decompression for hemifacial spasm. J Korean Skull Base Soc. 2007; 2:83–85.

12. Kong DS, Park K, Shin BG, Lee JA, Eum DO. Prognostic value of the lateral spread response for intraoperative electromyography monitoring of the facial musculature during microvascular decompression for hemifacial spasm. J Neurosurg. 2007; 106:384–387. PMID: 17367059.

13. Kuchta J, Møller AR, Wedekind C, Jannetta PJ. Delayed hearing loss after microvascular decompression of the trigeminal nerve. Acta Neurochir (Wien). 1998; 140:94–97. PMID: 9522915.

14. Kuroki A, Itagaki S, Nagai O. Delayed facial palsy after microvascular decompression for hemifacial spasm. Facial Nerve Res. 1991; 11:147–150.

15. Lovely TJ, Getch CC, Jannetta PJ. Delayed facial weakness after microvascular decompression of cranial nerve VII. Surg Neurol. 1998; 50:449–452. PMID: 9842870.

16. McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK. Microvascular decompression of cranial nerves : lessons learned after 4400 operations. J Neurosurg. 1999; 90:1–8. PMID: 10413149.

17. Olson S, Atkinson L, Weidmann M. Microvascular decompression for trigeminal neuralgia : recurrences and complications. J Clin Neurosci. 2005; 12:787–789. PMID: 16165362.

18. Onoda K, Ono S, Miyoshi Y, Tokunaga K, Date I. [Delayed hearing loss after microvascular decompression for hemifacial spasm : report of two cases]. No Shinkei Geka. 2006; 34:1045–1049. PMID: 17052017.

19. Patel SV, Mutyala S, Leske DA, Hodge DO, Holmes JM. Incidence, associations, and evaluation of sixth nerve palsy using a population-based method. Ophthalmology. 2004; 111:369–375. PMID: 15019392.

20. Rhee DJ, Kong DS, Park K, Lee JA. Frequency and prognosis of delayed facial palsy after microvascular decompression for hemifacial spasm. Acta Neurochir (Wien). 2006; 148:839–843. discussion 843. PMID: 16804640.

21. Santos-Lasaosa S, Pascual-Millán LF, Tejero-Juste C, Morales-Asín F. [Peripheral facial paralysis : etiology, diagnosis and treatment]. Rev Neurol. 2000; 30:1048–1053. PMID: 10904952.

22. She W, Dai Y, Du X, Yu C, Chen F, Wang J, et al. Hearing evaluation of intratympanic methylprednisolone perfusion for refractory sudden sensorineural hearing loss. Otolaryngol Head Neck Surg. 2010; 142:266–271. PMID: 20115986.

23. Wang HB, Fan ZM, Han J, Li KY, Fan Z. [Serious complications of the microvascular decompression in cerebellopontine angle]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2005; 40:352–356. PMID: 16229176.