Recurrent Factors and Reoperation Strategies in Microvascular Decompression for Hemifacial Spasm

OBJECTIVE: To investigate the factors contributing to the recurrence of hemifacial spasm after microvascular decompression (MVD) and the outcomes of reoperation with MVD. METHODS: The authors retrospectively collected clinical data from 24 patients with recurrent hemifacial spasm after MVD treated at the Department of Neurosurgery, Suzhou Kowloon Hospital, from January 2017 to December 2022. These patients underwent reoperation with MVD. The causes of recurrence were analyzed based on intraoperative findings. RESULTS: The causes of recurrence in the 24 patients were as follows: 10 cases due to excessive size or improper placement of the Teflon pledget compressing the facial nerve; 7 cases due to displacement or detachment of the Teflon pledget, leading to compression of the facial nerve by the original offending vessel; 3 cases due to compression by the vertebral artery with high tension, resulting in insufficient initial decompression; 3 cases due to compression by new offending vessels; and 1 case due to traction and distortion of the facial nerve caused by arachnoid adhesion and thickening. The average follow-up period was 49.2 months, with a surgical efficacy rate of 95.8% during follow-up. CONCLUSION: In cases of recurrent hemifacial spasm after MVD, improper placement of the Teflon pledget, leading to compression of the facial nerve exit zone by the vessel or pledget, is the main cause. Reoperation with MVD remains safe and effective for recurrent cases. The key to successful surgery includes the surgeon's proficient microsurgical techniques, rich surgical experience, cautious and patient intraoperative manipulation, and meticulous perioperative management.