Background : Microvascular decompression for hemifacial spasm provides a long- term cure rate. Delayed facial palsy has only been sporadically described in the literature. The purpose of this report is to evaluate the incidence of delayed facial palsy after MVD and its clinical course. Methods : From January, 1998 to April, 2005, 500 consecutive patients underwent microvascular decompression for hemifacial spasm in our institute. The male: female ratio was about 1:3 (131:369) and their mean age was 44.7 years (range: 19-75 years). We investigated the following clinical characteristics for all the patients: age, gender, side of spasm, the offending structures (the compressing vessels), and infection with herpes simplex virus. Their medical recording and radiological data were reviewed. Results : During this period, 49 patients (9.8%) developed delayed facial palsy after microvascular decompression. There were 38 women and 11 men in this study. The onset of palsy occurred between postoperative day 7 and 23 (average: 12.5 days). The palsy was at least Grade II or worse on the House-Brackmann scale. The mean time to recovery was 5.2 weeks (range: 25 days-17 weeks); delayed facial palsy in 48 patients were improved to the complete recovery, but only one patient had remained weakness at the follow-up examination. Conclusion : The incidence of delayed facial palsy (9.8%) was not so low as has been reported the literatures. Although the degree of facial palsy was variable, almost all patients exhibited a complete recovery without any further special treatment.
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