J Korean Neurosurg Soc.  2025 Jan;68(1):46-59. 10.3340/jkns.2024.0055.

Prediction of Hemifacial Spasm Re-Appearing Phenomenon after Microvascular Decompression Surgery in Patients with Hemifacial Spasm Using Dynamic Susceptibility Contrast Perfusion Magnetic Resonance Imaging

• Lim SH
• Guo XY
• Kim HG
• Ko HC
• Park S
• Ryu CW
• Jahng GH

• KMID: 2562982
• DOI: http://doi.org/10.3340/jkns.2024.0055

Abstract

Objective
: Hemifacial spasm (HFS) is treated by a surgical procedure called microvascular decompression (MVD). However, HFS re-appearing phenomenon after surgery, presenting as early recurrence, is experienced by some patients after MVD. Dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI) and two analytical methods : receiver operating characteristic (ROC) curve and machine learning, were used to predict early recurrence in this study.
Methods
: This study enrolled 60 patients who underwent MVD for HFS. They were divided into two groups : group A consisted of 32 patients who had early recurrence and group B consisted of 28 patients who had no early recurrence of HFS. DSC perfusion MRI was undergone by all patients before the surgery to obtain the several parameters. ROC curve and machine learning methods were used to predict early recurrence using these parameters.
Results
: Group A had significantly lower relative cerebral blood flow than group B in most of the selected brain regions, as shown by the region-of-interest-based analysis. By combining three extraction fraction (EF) values at middle temporal gyrus, posterior cingulate, and brainstem, with age, using naive Bayes machine learning method, the best prediction model for early recurrence was obtained. This model had an area under the curve value of 0.845.
Conclusion
: By combining EF values with age or sex using machine learning methods, DSC perfusion MRI can be used to predict early recurrence before MVD surgery. This may help neurosurgeons to identify patients who are at risk of HFS recurrence and provide appropriate postoperative care.

Keyword

Magnetic resonance imaging; Hemifacial spasm; Microvascular decompression surgery; Reappearing symptom; Extraction fraction

Figure

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  Fig. 1. Representative dynamic susceptibility contrast maps obtained from hemifacial spasm patients with (58-year-old, male) and without (56-year-old, male) reappearing symptoms after microvascular decompression surgery. rCBF is higher in patients without a reappearing symptom than in patients with a reappearing symptom, but EF is higher patients with a reappearing symptom than in patients without a reappearing symptom. rCBF : relative cerebral blood flow, rCBV : relative cerebral blood volume, MTT : mean transit time, EF : extraction fraction.

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  Fig. 2. Voxel-based independent t-test results between hemifacial spasm patients with and without reappearing symptoms after microvascular decompression surgery for each dynamic susceptibility contrast map. The red color indicates higher values in the no-reappearing group than the reappearing group, while the blue color indicates the opposite. Leakage and brain tissue volumes of gray matter and white matter were not significantly different between the two groups. rCBF : relative cerebral blood flow, rCBV : relative cerebral blood volume, MTT : mean transit time, EF : extraction fraction.

Reference

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