Outcomes and Safety of Overlapping Surgery in Patients Undergoing Microvascular Decompression for Hemifacial Spasm and Trigeminal Neuralgia

Abstract: Objective Overlapping surgery, performed by the same primary attending surgeon asynchronously, has gained significant attention from the government and media as potentially harmful to patients. Therefore, the goal of this study was to evaluate the outcomes and safety of overlapping versus nonoverlapping microvascular decompression (MVD) operation. Methods 1153 hemifacial spasm (HFS) patients (694 (60.2%) were overlapping) and 935 trigeminal neuralgia (TN) patients (612 (65.5%) were overlapping) undergoing MVD operations were retrospectively reviewed. Collected variables included patient age, sex, side, disease duration, clinical characteristic, comorbidity, offending vessel, intraoperative neuroelectrophysiology, operation time under microscope, total surgical procedure times, mean length of stay (LOS), efficacy (at discharge, 6-month, 1-year), short-term complications and long-term complications. Chi-square and t-tests were performed to compare overlapping versus nonoverlapping cases, and then multivariate analysis were conducted to adjust for patient demographics, clinical characteristics, and comorbidity between the 2 groups. Results Patient variables (age, sex, side, disease duration, clinical characteristic and comorbidity), offending vessel and intraoperative neuroelectrophysiology were similar between the 2 groups. After adjusting for patient demographics, clinical characteristics, and comorbidity, overlapping surgeries had longer total surgical procedure times (HFS: Standardized Coefficient= 0.066, P Conclusions Overlapping MVD operation may be performed safely at our institution. Further prospective studies are needed to understand the association of overlapping surgery among MVD operation.