Introduction: Hearing loss following microvascular decompression (MVD) for hemifacial spasm is
one of the most dreaded complications. Several factors such as stretching of VIII
cranial nerve, vasospasm of labyrinthine artery, and acoustic trauma due to drill
noise may be considered in its causation. We evaluated the incidence and severity
of hearing loss following MVD in hemifacial spasm and the factors which might be responsible
for this complication. Methods: A retrospective analysis of 30 patients operated for hemifacial spasm between January
1, 2014, and December 31, 2018, with at least 3 months of follow-up were included
in the study. Retromastoid craniotomy was made, and Teflon was placed between involved
vessel and VII nerve. Results: Freedom from hemifacial spasm was noted in 27 of 30 patients. Moderate spasm persisted
in one patient, which was controlled with medications. The recurrence was noted in
3 patients at 6 months follow-up. Postoperatively, hearing loss was found in one female
patient. The offending vessel was both anterior inferior cerebellar artery (AICA)
and posterior inferior cerebellar artery (PICA) loop, which was transpositioned during
surgery, and the patient was spasm free postoperatively. Conclusion: The incidence of hearing loss following MVD can be minimized using proper surgical
techniques and various intraoperative adjuncts such as brainstem auditory evoked responses
monitoring, use of endoscope, and indocyanine green or dual-image video angiography.
Key-words:
Hearing loss - microvascular decompression - retromastoid
