Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Ho KH(1), Lo KY(1), Li R(1)
Affiliation :
(1)Department of Neurosurgery, Kwong Wah Hospital
Introduction :
Hemifacial spasm (HFS) is a disorder characterized by involuntary contractions of the facial muscles on one side of the face. It is usually caused by a displaced artery or vein pulsating against the facial nerve at the brainstem, leading to hyper-excitability of the motor nucleus of the facial nerve. Treatment options include oral medications, botulinum toxin injections and surgery. Microvascular decompression (MVD) is a surgical procedure to isolates the facial nerve from abnormal cross-connections with neurovascular structures.
Objectives :
To review the clinical information of MVD and intra-operative neurophysiological monitoring (IONM) in Kwong Wah Hospital (KWH) and compare the result with recent international studies.
Methodology :
During MVD, different IONM modalities are used to maximize surgical outcome. Lateral spread response involving the stimulation of a branch of facial nerve and recording electromyogram (EMG) of muscles innervated by the other facial nerve branches is used to confirm adequate vascular decompression. Brainstem auditory evoked response is used for hearing preservation. Free run EMG and motor evoked potential of the facial nerve are used to prevent injury to neural structures. Clinical information on the rate of successful decompression, complications and the length of hospitalization were reviewed through patients record in KWH from 2021 to 2023. The results were compared with recent international studies.
Result & Outcome :
The success rate of MVD at KWH neurosurgery between 2021 and 2023 was 77%. Early discharge could be achieved as soon as post-op Day 3. 7.7% of patients had complications such as facial palsy. The successful and complication rates were aligned with recent international studies. MVD service and standard in KWH complies with international findings. MVD with IONM can enhance the success rate of the operation, shorten the hospitalization period and improve patient outcome.
