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Objectives: The objective of this study is to investigate the clinical characteristics, intraoperative findings, complications, and outcomes in these patients with hemifacial spasm (HFS) caused by venous compression. Methods: We analyzed 15 patients who underwent microvascular decompression (MVD) for HFS caused by venous compression performed at the University of Pittsburgh Medical Center between 1 January 2000 and 31 December 2007. Thirteen of 15 patients underwent repeat MVD, and two patients underwent their first MVD. Clinical data were collected to verify vein as real offending vessel for all of 15 patients with HFS. The mean follow-up period was 4.13 years (range: 1.29-6.76 years). Results: Thirteen patients with repeat MVDs had vein as the offending vessel, such as series of small venule, small veins, and dilated venous stump. The remaining two patients who underwent the first MVD had vein as the only offending vessel. In the first MVD for 13 patients, lateral spread response (LSR) disappeared in five patients (38.5%). In the repeat MVD for these 13 patients, LSR disappeared after the vein was decompressed completely in nine patients (69.2%). An excellent surgical outcome was observed in all the 11 patients with four patients lost during the follow-up period. Post-operative complications were observed in 12 patients included hearing loss, cerebrospinal fluid leakage, worsening facial palsy, difficulty swallowing, dilpopia, and ataxia. Conclusions: Vein can play an important role and can be the offending vessel in MVD for HFS. Women with platysmal involvement and tonus seem to have higher chance of vein as an offending vessel. These patients that have residual LSR at the end of the procedure should undergo exploration for a vein to prevent persistent HFS. Intraoperative monitoring with LSR is an effective tool to evaluate adequate decompression to vein. Although the long-term outcome is excellent for venous compression, the complication rate is much higher. To decrease the complication rate, gentle retraction of the cerebellum and 'low-power' coagulation of the vein might be helpful. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Facial nerve microvascular decompression (MVD) for hemifacial spasm (HFS) provides relief to most patients. Due to the proximity of the cochlear and facial nerves, hearing loss is a potential MVD complication, however, there is a wide range in the reported incidence of hearing loss (HL) in the literature. In order to better understand the HL incidence in our MVD population, we utilized the combination of speech discrimination scores (SDS) and air and bone pure tone threshold averages (PTA) to identify patients with no hearing change, sensorineural hearing loss, or conductive hearing loss. We also assessed the predictive value of patient-reported hearing deficits on the ultimate audiometric diagnosis of hearing loss. Methods: One hundred and fifty one patients underwent facial nerve MVD at the University of Pittsburgh Medical Center between January 2000 and December 2007. Peri-operative audiometric data, including changes in air and bone pure tone thresholds and speech discrimination scores, were analyzed retrospectively. Criteria from the 1995 American Academy of Otolaryngology Committee on Hearing and Equilibrium consensus were used to analyze post-operative hearing loss. Patient-reported hearing disturbances obtained in the immediate post-operative period were compared to seven-day post-operative conductive and sensorineural HL status. Results: Non-functional, non-serviceable HL (Class D) occurred in 6.6% of patients, while 10.6% developed cumulative non-functional HL (Class C and D). Twenty-nine patients (18.7%) exhibited conductive HL. While patient-reported complaints were predictive of Class C/D HL (<0.0001) with a 56.3% sensitivity and 92.6% specificity, patient-reported complaints were not strongly associated with conductive HL status (p =0.369) with 17.2% sensitivity and 88.5% specificity. Conclusions: Perioperative hearing evaluations, in conjunction with careful scrutiny of patient complaints and air-bone pure tone testing enables the physician to more precisely quote complication rates and rapidly distinguish potentially reversible conductive hearing pathologies from permanent sensorineural disorders. [Copyright &y& Elsevier]