To discuss the surgical techniques, outcomes and complications of microvascular decompression (MVD) for treatment of hemifacial spasm (HFS) with offending vessels including the vertebral artery (VA).

A total of 783 patients with HFS undergoing MVD at Department of Neurosurgery, China-Japan Friendship Hospital from January 2010 and February 2012 were retrospectively enrolled into this study. Among them, 125 cases (16.0%) were found to have offending vessels including VA and were classified into VA group. The other 685 cases (84.0%) did not have VA as the offending vessel and belonged to non-VA (NVA) group. The clinical characteristics, surgical techniques, efficacies and complications were analyzed for the two groups.

In the VA group, 120 cases (96.0%) had offending vessels including VA and other arteries. Out of the 120 cases, VA acted as the only main offending vessel or one of the main offending vessels in 11 cases, and as the secondary offending vessel in 109 cases. VA was identified as the only offending vessel in 5 cases (4.0%). Compared with the NVA group, the symptoms in VA group seemed to affect more commonly the left side and male patients (all P<0.05). The mean follow-up time is 51 months(range from 46 to 60 months). In the VA group, the postoperative recurrence rate, delayed curing rate, median delayed curing time and rates of significant ipsilateral hearing loss, immediate postoperative facial paralysis, delayed facial paralysis, injury of posterior group of cranial nerves as well as intracranial bleeding were all higher than those in NVA group, and the differences were statistically significant (all P<0.05). Between the two groups, no difference was identified in the patient's age, duration of illness, effective or non-effective rate of operation (all P>0.05).

It seems uncommon that VA acts as the only major offending vessel, which tends to be the secondary offending vessel and results in compression together with other arteries. The efficacy of MVD in HFS involving offending vessels including VA is suggested to be certain. Compared with the NVA patients, delayed curing is more likely to occur with later remission and higher rate of recurrence in VA patients. Postoperative complications post MVD are more commonly observed in VA patients than in NVA patients.

Hemifacial spasm; Microvascular decompression; Vertebral artery; Treatment outcome; Postoperative complications