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A significant correlation between delayed cure after microvascular decompression and positive response to preoperative anticonvulsant therapy in patients with hemifacial spasm

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タイトル: A significant correlation between delayed cure after microvascular decompression and positive response to preoperative anticonvulsant therapy in patients with hemifacial spasm
著者: Terasaka, Shunsuke 著作を一覧する
Asaoka, Katsuyuki 著作を一覧する
Yamaguchi, Shigeru 著作を一覧する
Kobayashi, Hiroyuki 著作を一覧する
Motegi, Hiroaki 著作を一覧する
Houkin, Kiyohiro 著作を一覧する
キーワード: Anticonvulsant therapy
Clonazepam
Delayed cure
Hemifacial spasm
Microvascular decompression
発行日: 2016年10月
出版者: Springer
誌名: Neurosurgical review
巻: 39
号: 4
開始ページ: 607
終了ページ: 613
出版社 DOI: 10.1007/s10143-016-0729-4
抄録: Objective: Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), the postoperative course is varied. We retrospectively analyzed the resolution pattern of the spasm and specified predictors for delayed cure after MVD. Methods: This study included 114 consecutive patients with typical HFS. All of them were followed-up for at least one year after operation. Patients were divided into three groups depending on the postoperative course: immediate cure, delayed cure, and failure. To identify the predictive factors for delayed cure after MVD, logistic regression analyses were applied using candidate clinical factors, such as duration of symptom, the tendency of the spasm, preoperative medical treatment and offending vessels. Results: Among the 114 patients, 107 patients were cured. For those cured, 65 patients were classified as immediate cure and 42 patients were classified as delayed cure. Cumulative spasm free rate after one week, one month, and 3 months after MVD were 70%, 88%, and 97%, respectively. No predictive factors between the cured and failure groups were observed. According to multivariate analysis, preoperative anticonvulsant therapy was found to be the sole significant predictive factor for delayed cure after MVD (p = 0.025). Conclusions: A significant correlation between delayed cure and preoperative anticonvulsant therapy was found in our study, which suggests that hyperexcitation of the facial nucleus plays an important role in pathogenesis of delayed cure. Therefore, if a patient demonstrating a positive response to preoperative anticonvulsant therapy showed a persistent spasm after MVD, reoperation should be delayed for at least 3 months after the initial operation.
Rights: The final publication is available at Springer via http://dx.doi.org/10.1007/s10143-016-0729-4
資料タイプ: article (author version)
URI: http://hdl.handle.net/2115/67228
出現コレクション:雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

提供者: 寺坂 俊介

 

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