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investigated the efficacy of intraoperative monitoring in predict- from 322 operations performed on 293 patients with HFS; 29
ing spasm persistence or resolution and identified clinical char- operations were reexploration surgeries due to persistent or
acteristics that can potentially predict surgical outcome. recurrent spasm. The patient population consisted of 103 men and
190 women ranging in age from 17 to 82 years (mean: 52.25
METHODS years). Clinical outcome data were obtained immediately after
the operation, at discharge (mean: 3.91 ⫾ 1.98 days), and at a
Microvascular Decompression follow-up phone call during June 2008. Follow-up data were
Between January 2000 and December 2007, our center collected from 208 patients who had a minimum follow-up period
performed 326 retromastoid MVD procedures for HFS. Preoper- of 9 months (mean: 54.5 ⫾ 27.8 months). We attempted to
atively, all patients received a cranial MRI, audiometry, and contact every patient identified during the record screening to
facial EMG testing. Decompression was achieved by placing obtain information regarding the patient’s present spasm status
Teflon pledgets between the facial nerve as it exited the brain- and operative complications and to confirm the accuracy of data
stem and the offending vessels, and/or by elevating and cauter- collected from clinical notes and statements. Outcomes were
izing compressive veins that could not be safely decompressed divided into two categories: success (spasm relief) and failure
with Teflon. During surgery, facial EMG monitoring was per- (persistent spasm). Postoperative success was defined as com-
formed from the initiation of general anesthesia until the time of plete spasm resolution with no residual twitching within 24 hours
dural closure. Stimulating needle electrodes were inserted intra- of operation and no more than two episodes of residual eye
dermally over the zygomatic branches of the facial nerve at the twitching before discharge. At follow-up, complete relief was
middle point of a line between the ipsilateral tragus and external defined as the reported absence of HFS, allowing for residual eye
canthus of the eye. A 0.2- to 0.3-millisecond pulse wave with an twitching at a frequency no more than one episode per month.
intensity of 5 to 25 mV was applied. On stimulation of the Patients who experienced waxing and waning symptoms were
zygomatic branch, which primarily innervated the orbicularis asked to rate the frequency and severity of their current symp-
oculi muscle, the team recorded and reviewed the evoked LSR toms on a 1 to 10 scale. Patients were instructed to consider their
that appeared in the other facial muscles via peripheral branches, preoperative symptoms as a 10 and rate their current symptoms in
including the frontalis (temporal), orbicularis oris (buccal) and comparison to that value. Patients who reported spasm with
mentalis (marginal mandibular) muscles (Fig. 1). The eighth frequency and severity ⬎3 on a 10 scale when compared with
cranial nerve (CN VIII) function was concurrently monitored by their preoperative spasm were considered to have persistent
looking for waveform shifts during the recording of brainstem spasm. To minimize bias, an investigator other than the operating
auditory evoked responses. In some cases, use of neuromuscular surgeons and neurophysiologists conducted all of the telephone
blockade during anesthesia led to alterations in the LSR phenom- interviews. Also, investigators responsible for collecting patient
enon due to muscular paralysis. Therefore, the anesthesiologist data at all three time points were blinded to LSR results.
used a technique that maintained the train-of-four ratio at a level Statistical analyses were performed using SAS version 9.1.3
of at least 0.75. When complete decompression was achieved, the (SAS Institute, Cary, NC). Continuous variables were presented as
LSR was found to disappear in most patients. When the LSR mean ⫾ standard deviation and categorical variables as frequency
persisted or simply decreased in amplitude, the surgeon looked (%). Group differences in demographic, clinical characteristics, and
again for persistent arterial or venous compression. Residual LSR outcomes were assessed using t tests, 2 tests, and Fisher exact tests
was characterized as either an LSR that returned after initially when appropriate. Logistic regression models were conducted to
disappearing during the procedure (after disappearing [AD]) or evaluate the association of LSR and outcome at each time point
an LSR that persisted relatively unchanged throughout the de- while adjusting for age, gender, prior BT use, platysmal spasm,
compression (never disappearing [ND]) (Fig. 2). After confirm- preoperative facial weakness, and side of spasm. P ⬍ 0.05 was
ing that there were no further offending vessels, the surgeon considered as statistically significant.
terminated the procedure and closed the craniotomy in a routine
fashion.
RESULTS
Data Collection and Analysis
A retrospective study was conducted with Institutional Demographics
Review Board approval from the University of Pittsburgh (IRB #: Mean patient age was 52.25 ⫾ 12.05 years (range, 17– 82
PR008120394). Of 326 MVD procedures, data were collected years), with women to men ratio being 1.8:1. No patients exhibited
FIGURE 2. Recording of the stimulus-evoked EMG responses from two different patients at the orbicularis oculi (A) and men-
talis (B) muscles in response to stimulation of the zygomatic branch of the facial nerve. On decompression (arrow; A), the
paradoxical LSR (mentalis) becomes variable in amplitude and morphology (after disappearing) and on complete decompres-
sion (B), the LSR eventually disappears with no significant change observed from the oculi muscle group.
bilateral HFS (see Appendix, Table A2). The mean follow-up period Preoperative Characteristics
was 54.5 ⫾ 27.8 months (range: 9 –102 months) (Table 1). Seven patients had evidence of a Chiari I malformation on
radiographic imaging. Nine patients had symptoms of atypical HFS
Medical Hx (spasms began in the buccal-oral muscles and then progressed to
Medical and surgical histories were obtained from each involve the orbicularis oculi muscle). Sixty-seven (22.8%) pa-
patient undergoing MVD. Twenty-two patients underwent a prior tients exhibited moderate-to-severe preoperative facial weakness,
MVD at an outside institution. Two hundred seventeen patients as determined by the House-Brackmann score (House and Brack-
(74.6%) received prior BT treatment, with the average time mann, 1985) (grade III and higher). Of note, patients with prior
between the last injection and the most recent operation being 12 BT treatment were significantly more likely to demonstrate
months (range: 1– 49 months). Patients who underwent BT treat- moderate-to-severe preoperative facial weakness (P ⫽ 0.01). One
ment did so over a variable period (average: 4.23 years, range: 2 hundred thirty-seven (49.6%) patients had platysmal spasm, while
months–14 years). Common medications used to control HFS 187 (85.8%) exhibited tonus (frequent eyelid locking), signs associated
symptoms, including anticonvulsants and antipsychotics, are with an extended spasm history. One hundred twenty-six (43.0%)
listed separately (see Appendix, Fig. A2). There was no gender patients reported specific triggers that would initiate spasms. Thirty-six
bias regarding patients undergoing prior BT treatment (P ⫽ (12.3%) patients demonstrated functional hearing loss, as determined
0.561). by the pure tone average during preoperative audiograms.
tonus, or type of decompressed vasculature and outcome at any of history of BT injections, or tonus/platysma involvement (Fig. 3).
the time points. Although no statistical difference existed with regard to preoperative
facial weakness, we observed an increasing proportion of patients
Intraoperative Lateral Spread Monitoring with greater degrees of preoperative paresis having postoperative
Categorizing LSR at Termination of MVD residual LSR (grade I, II: 15.5%; grade III: 17.0%; grade IV:
Data regarding intraoperative monitoring of the LSR during 40.0%). More patients requiring venous decompression had residual
MVD were available for 259 (87.4%) of the 293 patients. LSR on postdecompression LSR (51.9%) than did those without venous
other 12.3% of patients was collected but could not be located for involvement (42.0%) (P ⫽ 0.199). Reexploration patients (including
review at the time of this study. We divided these 259 patients into operations at our institution) were more likely to have LSR resolu-
two groups, according to the disappearance (group I: LSR ⫽ 0) or tion at MVD termination (85.1%) when compared with first-time
persistence (group II: LSR ⬎0) of facial EMG activity immediately operations (78.8%) (P ⫽ 0.327).
after decompression (see Appendix, Fig. A1). Demographic data
were not significantly different between groups (Table 4). LSR Outcomes: Short-Term Prognostic Value
disappearance (group I) was observed after facial nerve decompres- Within group I, (patients in whom the LSR disappeared after
sion in 207 of 259 patients (79.9%). Fifty-two patients (20.1%) had decompression), spasms completely disappeared postoperatively in
residual LSR postoperatively (group II). Five of these patients had 195 of 207 patients; LSR monitoring therefore had a negative
an LSR amplitude increase when compared with baseline. predictive value (NPV; proportion of patients without residual LSR
There was no statistically significant difference between that are spasm-free) of 94.7%. In contrast, only 67.3% of group II
group I and II with regard to laterality, compressing vasculature, patients (patients in whom residual LSR was present after decom-
pression) experienced immediate postoperative relief; the positive
predictive value (proportion of patients with residual LSR that have
TABLE 4. Patients With Measured LSR: Demographics persistent spasm) was 32.7% (Fig. 4). The specificity and sensitivity
of intraoperative LSR monitoring for predicting postoperative sur-
Group I: Group II: gical outcome were 60.7% and 84.8%, respectively (see Appendix,
Parameter LSR ⴝ 0 LSR >0 P
Table A3).
No. patients 207 52 — There was a statistically significant difference in the postop-
Gender (M:F) 72:135 19:33 0.813 erative spasm relief outcomes between the two groups (P ⬍ 0.0001),
Age 0.638 a trend which was also evident at discharge (94.2% vs. 76.9%) (P ⫽
Mean age (years) 51.9 52.8 0.001). Five group II patients with postoperative spasm had com-
No. patients aged ⬍50 years 85 19 plete relief by discharge. When 32 patients in group II were
No. patients aged ⱖ50 years 122 33
subdivided by whether the residual LSR was present throughout the
entire operation (ND), or returned after initially disappearing during
Operation 0.327
the operation (AD), no statistically significant difference in out-
First-time 167 45 comes was identified. All group II patients with follow-up data
Reexploration 40 7 whose LSR reappeared after initially resolving during the decom-
Mean time to FUP (months) 57.1 51.1 — pression (AD) described complete spasm relief at follow-up. Of six
Residual LSR classification — group II patients whose residual LSR was persistent during the
After disappearing — 23 entirety of the decompression (ND), one patient declared persistent
Never disappearing — 9 spasm at follow-up.
When separating patients in groups I and II by BT history or
LSR, lateral spread response; FUP, follow-up.
gender, we found no differences from the outcomes seen when
FIGURE 5. MVD Outcomes at three major time points. A, Outcomes in patients without prior Botox treatment. B, Out-
comes in patients with prior Botox treatment. C, Operative outcomes with respect to residual LSR status. ***P ⬍ 0.0005;
**P ⬍ 0.005, when compared with patients without residual LSR.
TABLE 5. Logistic Regression Analysis of the Association Between Perioperative Risk Factors and Spasm Persistence
Postoperative Discharge Follow-Up
OR (95% CI) P OR (95% CI) P OR (95% CI) P
Residual LSR 9.59 (3.73–24.65) ⬍0.0001 5.50 (2.21–13.73) ⬍0.001 1.03 (0.19–5.43) 0.977
Gender 0.75 (0.28–2.03) 0.572 0.43 (0.14–1.27) 0.127 0.13 (0.02–1.07) 0.058
Age ⱖ50 years 1.93 (0.71–5.21) 0.197 1.04 (0.42–2.61) 0.931 1.37 (0.36–5.15) 0.643
Prior BT use 0.42 (0.15–1.18) 0.098 0.41 (0.15–1.12) 0.081 3.03 (0.34–26.92) 0.321
Platysmal spasm 5.46 (1.88–15.90) 0.002 2.74 (1.03–7.27) 0.043 6.29 (1.25–31.55) 0.025
Weakness (H-B III, IV) 1.86 (0.67–5.19) 0.238 1.65 (0.58–4.65) 0.347 0.21 (0.02–1.77) 0.150
Left-sided spasm 0.74 (0.29–1.91) 0.537 0.95 (0.38–2.38) 0.907 1.35 (0.38–4.79) 0.641
Reference group: gender (female), age ⬍50 years, no prior BT use, no platysmal spasm, H-B score 0/I/II (none or mild weakness), left-sided spasm.
LSR, lateral spread response; BT, botulinum toxin; OR, odds ratio; CI, confidence interval. Bold indicates statistical significance.
comparing groups I and II as a whole. In patients without previous toring for long-term outcomes was 93.3%. There was no significant
BT use (n ⫽ 68), group I subjects (no postoperative LSR) were statistical difference even when specifically considering patients
significantly more likely than those in group II (residual postoper- without previous BT injections (P ⫽ 0.688), female patients (P ⫽
ative LSR) to have complete relief within 24 hours of the operation 1.000), and patients with recent follow-up (⬍2 years) (P ⫽ 0.402).
(96.3% vs. 50.0%) (P ⫽ 0.0001) and at discharge (94.4% vs. 57.1%)
(P ⫽ 0.0002). This association was also true for patients with
previous BT injections (n ⫽ 189) postoperatively, although with less Multivariate Logistic Regression Model
statistical significance (94.1% vs. 75.7%) (P ⫽ 0.002). However, the The association between predisposing factors and spasm
outcomes of group I and II patients did not significantly differ at status at each time point was examined with a multivariate logistic
discharge (94.1% vs. 83.8%) (P ⫽ 0.081) when considering prior regression model (Table 5). Predicting variables controlled for
BT use (Fig. 5). Within the BT use subgroup, postoperative spasm included residual LSR, gender, age (ⱖ50 years or ⬍50 years), prior
disappeared in three patients with residual LSR by the time of BT treatment, platysmal spasm, preoperative facial weakness (H-B
discharge. When separating patients by gender, the association grade 0/I/II [absent/mild], or III/IV [moderate/severe]), and lateral-
between residual LSR and persistent spasm was strongest within 24 ity (left or right). Postoperatively, persistent spasm was associated
hours of the operation (men: P ⫽ 0.0017; women: P ⬍ 0.0001) and with residual LSR (odds ratio [OR]: 9.59; 95% confidence interval
remained significant for women at the time of discharge (P ⬍ [CI]: 3.73–24.65; P ⬍ 0.0001) and preoperative platysmal spasm
0.001). (OR: 5.46; 95% CI: 1.88 –15.90; P ⫽ 0.002). At discharge, residual
LSR (OR: 5.50; 95% CI: 2.21–13.73; P ⬍ 0.001) and platysmal
Outcomes: Long-Term Prognostic Value involvement (OR: 2.74; 95% CI: 1.03–7.27; P ⫽ 0.043) were also
At the time of follow-up phone call with 208 patients, the predictive of present spasm. However, at follow-up, only preoper-
outcomes between group I and II patients did not significantly differ ative platysmal spasm was associated with persistent spasm (OR:
(93.3% vs. 94.4%) (P ⫽ 1.000), although the NPV of LSR moni- 6.29; 95% CI: 1.25–31.55; P ⫽ 0.025). Men tended to report spasm
less frequently than women (OR: 0.13; 95% CI: 0.02–1.07; P ⫽ follow-up, could also be indicative of a different pathology for the
0.058). patient’s spasm or an incomplete decompression. It is hypothesized
that delayed LSR resolution is due to a variable duration for
restoration of CN VII firing thresholds or remyelination in different
DISCUSSION patients (Goto et al., 2002; Huang et al., 1992; Ishikawa 2001; Li,
CN VII MVD is an effective treatment for HFS. In our 2005). In addition, BT-induced and postoperative facial weakness
experience with 326 operations, postoperative outcomes, with re- can make it difficult to ascertain spasm status in patients with subtle
spect to demographic variables, concurred with the results of pre- but persistent symptoms, detracting from the predictive value of the
vious studies (Barker et al., 1995; Ishikawa et al., 2001; Lovely et LSR in these subgroups.
al., 1998) Men demonstrate a greater relief rate compared with Some authors have described the significant predictive value
women, a trend that was especially apparent at the time of follow- of the LSR for outcomes at 1-year follow-up (Kong et al., 2007;
up, and patients aged 50 years and older at the time of operation Moller and Jannetta, 1987), whereas others question its value (Ha-
have a similar resolution rate to that of younger patients (Shin et al., tem et al., 2001; Joo et al., 2008; Kiya et al., 2001). We, too,
1997). Although a majority of patients presented with left-sided investigated the predictive value of the LSR on long-term outcomes
spasm, laterality did not affect outcome. Outcome was not contin- in our series. Our follow-up data were collected from patients with
gent on vessel type, although multiple vessels were frequently seen a mean follow-up period of 54.5 months, whereas prior studies
compressing the nerve. Excellent outcomes were achieved in the document relatively short-term follow-up, with a mean period ⬍1
majority of patients within 24 hours of surgery (88.0% spasm-free). year (Sekula et al., 2009). Although we did not find a significant
Eight additional patients achieved complete relief during their inpa- statistical correlation, LSR resolution was predictive of spasm relief
tient stay, increasing the resolution rate to 90.8% at discharge. Only at follow-up (NPV ⫽ 93.3%). However, residual LSR does not
16 patients with follow-up (7.7%) had symptoms, demonstrating the
always correlate with a poor outcome because it may take several
long-lasting effects of MVD. The delayed spasm resolution may be
months for nerve excitability to normalize.
attributed to the time required for remyelination of the damaged
Therefore, we recognize the importance of intraoperative
area, as well as the return of normal excitability of the facial
LSR monitoring and agree with prior studies that recommend
motonucleus (Ishikawa, et al., 1997; Moller and Jannetta, 1985,a,b;
postoperative facial EMG testing. In addition to detecting when the
Yamashita et al., 2001).
LSR is fully normalized, postoperative testing can confirm that
Facial EMG monitoring aids in the perioperative diagnosis of
HFS-related complexes, synkinesis, and cross talk are eliminated
HFS and has been considered by us to be a valuable intraoperative
tool in ensuring a meticulous CN VII decompression. Pulsatile and can thus be helpful in determining prognosis of persistent
compression at the CN VII RExZ leads to the LSR (Ishikawa et al., spasm, ascertaining recurrence, and planning for reexploration. Kim
1996b; Jannetta et al., 1970; Moller and Jannetta, 1986). In line with and Fukushima (1984) showed that synkinesis remains in the orbic-
recent studies (Isu et al., 1996; Kong et al., 2007; Sekula et al., 2009; ularis oris and mentalis muscles on postoperative facial EMG
Shin et al., 1997) demonstrating the usefulness of intraoperative monitoring 10 days after surgery. In evaluating outcomes after MVD
LSR monitoring, we found that the disappearance of LSR at the end for HFS, it is therefore important to continue observing patients with
of MVD was predictive of spasm relief both immediately after the persistent spasm and discuss the likelihood of delayed resolution
surgery (NPV ⫽ 94.7%) and at discharge. This finding was also true with the patient before considering reoperation. This can be difficult
when focusing on individual genders and BT history, although the in practice because the refractory symptoms can be debilitating to
short-term correlation was weaker for those with prior BT injections. the already anxious patient, and there is no guarantee of resolution
In light of the excellent surgical outcomes in ⬎90% of patients at even after 1 year. Also, early reoperation has been found to correlate
discharge, we believe that intraoperative monitoring is an effective with better outcomes compared with patients receiving late reopera-
tool in identifying culprit vessels. Given the significant negative tions in one study (Engh et al., 2005), but complication rates for
predictive value of LSR monitoring, the surgeon can be reassured additional MVD operations need to be considered. Other institutions
that an adequate decompression has been achieved and avoid un- have advocated waiting 1 to 2 years before considering reoperation
necessary operation time and resultant complications, especially (Goto et al., 2002; Ishikawa et al., 2001; Li et al., 2005). Repeat
when multiple vessels are involved. However, we did find that EMGs may provide more insight into the neurophysiologic status of
several patients with residual LSR were spasm-free after the surgery, patients with persistent spasm and can be implemented before
reducing the positive predictive value of LSR monitoring for short- reoperation.
term outcomes. This appeared to be more common when the nerve The use of BT injections has long been advocated as a quick,
was found to be compressed by veins. noninvasive treatment for HFS, as well as blepharospasm (Laskawi,
In five patients with residual LSR and immediate postopera- 2008), dystonias (Benecke and Dressler, 2007), and various other
tive spasm, symptoms disappeared by the time of discharge. Several disorders involving muscle overactivity. However, BT frequently
more reported relief at follow-up, which detracted from the positive results in facial paresis (Yamashita et al., 2002). Patients also tend
predictive value of LSR for long-term outcomes. All patients with to become refractory to treatment, requiring larger and more fre-
follow-up data whose residual LSR reappeared after initially disap- quent toxin doses over time, resulting in recurrent spasms. It is
pearing (AD) were spasm-free at follow-up, whereas only one significant that almost three quarters of patients who underwent
patient with persistent intraoperative LSR (ND) had refractory MVD have tried and been unsuccessful with BT in the past. This
spasm. A returning LSR (AD) may be the factor of additional minor represents a larger proportion of patients who tried BT compared
vessel or dural involvement that resolves after hospital stay. Of note, with that of previous series (Yamashita et al., 2002), pointing to
when the LSR is found to reappear after initially disappearing, the increasing popularity. Although a statistically insignificant trend, the
surgeon will make the decision whether to continue surgery and look observation that 15 of 16 patients expressing persistent spasm at
for additional compressing vasculature. Therefore, the proportion of follow-up had received preoperative BT injections raises the issue
patients with postoperative residual LSR at our center is compara- that this drug may predispose a patient to recurrent spasm. We also
tively less because several potential AD cases were resolved after found that severe preoperative facial weakness, which can occur
further investigation into the compression. A persistent intraopera- after repeated BT treatment (House-Brackmann grade III or greater),
tive LSR (ND), although not significantly predictive of spasm at is predictive of poor surgical outcome. To explain these findings, it
is possible that paretic muscles (including those with weakness 1. Men expressed a greater relief rate compared with women at
secondary to BT injections) have lower thresholds for firing during follow-up (P ⫽ 0.01).
a period of spasmodic activity. A recent study suggests the HFS 2. A BT treatment history, which was positive in three quarters of
leads to mild facial nerve injury, which leads to greater vulnerability patients, was associated with preoperative facial weakness
to BT injections (Misawa et al., 2008). (P ⫽ 0.01) and was also common in patients reporting spasm
In addition to preoperative paresis, involvement of the at follow-up (P ⫽ 0.076).
platysma muscle is another indicator of long-standing and severe 3. Preoperative facial weakness correlated with persistent spasm
spasm. Preoperative platysma muscle spasm was also found to within 24 hours of operation (P ⫽ 0.012) and at discharge
correlate with poor outcome within 24 hours of surgery. In the (P ⫽ 0.016), with a similar trend at the time of follow-up (P ⫽
univariate analyses, platysmal involvement did not correlate with 0.056).
spasm at discharge or follow-up, suggesting that the normal firing 4. Preoperative platysmal spasm correlated with persistent spasm
activity in different branches of CN VII is not immediately restored within 24 hours of operation (P ⫽ 0.022) and exhibited a
after decompression. However, we found a significant association similar trend at the time of follow-up (P ⫽ 0.069). When
between platysmal spasm and postsurgical spasm status when con- controlling for other perioperative characteristics, we found a
trolling for other perioperative characteristics in the multivariate significant association of preoperative platysmal involvement
analyses. Therefore, patients with these progressive symptoms are with poor postoperative surgical outcome (OR: 5.46; 95% CI:
strongly encouraged to seek neurologic consultation and consider 1.88 –15.90; P ⫽ 0.002), positive spasm status at discharge
MVD to improve their prognosis after surgery. (OR: 2.74; 95% CI: 1.03–7.27; P ⫽ 0.043), and persistent or
Study limitations include the inherent bias in evaluating LSR recurrent spasm at follow-up (OR: 6.29; 95% CI: 1.25–31.55;
monitoring, which was actively being used to make intraoperative P ⫽ 0.025). It is recommended that patients with progressive
decisions, along with the absence of a control group. In addition, the symptoms (affecting multiple facial muscle groups) consider
“all-or-nothing” nature of the LSR categorization (LSR ⫽ 0 or LSR MVD and undergo surgery before muscles of the lower face
⬎0) may account for some of the patients with persistent LSR but and neck become involved.
resolved spasm; even 95% disappearance of LSR was considered 5. LSR monitoring was predictive of surgical outcomes within 24
LSR persistence in this study. Finally, follow-up data may be hours of operation (P ⬍ 0.0001) and at discharge (P ⫽ 0.001).
problematic because some patients may not be objective about their When we adjusted for clinical and demographic variables, we
clinical condition. Further investigations, which decrease the reli- found residual LSR to be significantly predictive of persistent
ance on self-interpretation of surgical results, would be beneficial. postoperative spasm (OR: 9.59; 95% CI: 3.73–24.65; P ⬍
0.0001) and spasm at discharge (OR: 5.50; 95% CI: 2.21–
CONCLUSIONS 13.73; P ⬍ 0.001).
MVD for HFS is an effective treatment that can offer perma- 6. Although LSR monitoring was not statistically associated with
nent symptom resolution. We identified preoperative clinical char- long-term reported outcomes (P ⫽ 1.00), postoperative LSR
acteristics that affect outcome after MVD. Pertinent findings of this resolution was predictive of long-term spasm relief (NPV:
study include the following: 93.3%).
APPENDIX
TABLE A1. Microvascular Decompression Success Rate by TABLE A4. Reexploration Surgeries (University of
Gender-Age Subgroups Pittsburgh Medical Center)
Age (Years) Male (%) Female (%) No. Patients
n With Spasm
Postoperative
⬍50 86.4 95.3 Time since previous MVD (n ⫽ 29)
ⱖ50 91.1 88.7 ⬍1 month 16 2
P 0.676 0.163 ⬍1 year 8 0
Discharge ⱖ1 year 5 0
⬍50 90.9 98.4 Time since recurrence (n ⫽ 17)
ⱖ50 91.1 90.1 ⱕ1 week 9 1
P 0.999 0.065 ⬎1 week 8 0
Follow-up MVD, microvascular decompression.
⬍50 100.0 97.5
ⱖ50 96.9 90.4
P 0.999 0.228 TABLE A5. Prognosis of First-Time vs. Reexploration
Patients
First- Redo: Redo:
TABLE A2. Microvascular Decompression—Demographics Time Reexploration Other Within
Outcome Patient Patient P Institution UPMC P
Parameter Male Female
Postoperative 87.6 90.2 0.597 86.4 (19) 93.1 (27) 0.641
Mean age (years) 53.2 50.9
Discharge 91.6 86.3 0.283 90.9 (20) 82.8 (24) 0.684
No. patients postoperative 75 148
Follow-up 93.6 85.7 0.155 78.6 (11) 90.5 (19) 0.369
% patients with follow-up data (n) 68.0 (51) 66.2 (98)
Mean time to follow-up (months) 66.1 70.7 Values are presented as % or % (n).
UPMC, University of Pittsburgh Medical Center.
% with recorded (n) 84.0 (63) 89.2 (132)
% with repeat operations (n) 12.0 (9) 18.2 (27)