Middle-term results of surgical treatment of patients with hemifacial spasm using Sindou classification

Abstract

Rationale: Modern literature contains a large number of works assessing the effectiveness of surgical treatment of hemifacial spasm (HFS). However, only a few present an analysis of results with a follow-up period of more than 6 months. This study demonstrates the results of patient follow-up for 12 months or more.Purpose of the study: Identification of possible patterns of outcomes of HFS surgical treatment during a follow-up period of 12 months or more. Methods: The study included 84 patients who underwent vascular decompression of the facial nerve between 2018 and 2022. The duration of the history of hemifacial spasm in the presented patients ranged from 1 year to 18 years with an average of 5 years and 10 months. In order to assess treatment results, the Sindou et al. scale was used. Results: At discharge, 92.8 % of the patients underwent successful surgery; of these, the majority (73.8 %) were completely free of spasticity symptoms, which corresponded to «0» on Sindou scale. Six months after surgical treatment, the distribution of the patients was somewhat different from that in the early postoperative analysis. In contrast to the early assessment of spasticity, the delayed assessment showed that 67.8 % of the operated patients out of the total number of the patients did not have clinical signs of hemifacial spasm 6 months after the intervention. 17.9 % had symptoms corresponding to grade I, that is, rare twitching of the facial muscles, which did not significantly affect the patient’s well-being. 5.9 % of the patients had grade II clinical condition, and 8.4 % had grade III, when the result was assessed as «unsatisfactory». One year after surgery, we did not observe significant differences from the data presented after 6 months: 67.1 % still had no symptoms of spasticity, 18.75 % corresponded to grade I, 6.25 % — to grade II, and 7.8 % of the patients presented in the study belonged to grade III. Conclusion: Today, vascular decompression is the most effective method of HFS etiopathogenetic treatment. The data obtained during the study show that a result that satisfies both the doctor and the patient is achievable in most cases, and our study confirms this. After all, one of the most important aspects of such surgery, performed not as a life-saving operation, but in order to improve the patient’s quality of life, is the maximum possible reduction in the likelihood of developing complications that subsequently affect the lives of such patients.