Hemifacial Spasm: Comparison of Results between Patients Older and Younger than 70 Years Operated on with Microvascular Decompression.

OBJECTIVE: The aim of the present study was to evaluate the efficacy and safety of microvascular decompression (MVD) for primary hemifacial spasm (HFS) in patients aged ≥70 years and to compare the outcome with a control cohort of younger patients(<70 years). METHODS: In this retrospective study, subjects were divided into two groups: an elderly group (patients who were ≥70 years) and a younger group. We compared demographic and clinical data, surgical outcome, MVD-related complications, and duration of operation and hospitalization after MVD between the two groups. RESULTS: At a mean follow-up of 32 ± 4.2 months, 188 elderly patients (90.4%) reported an effective outcome without need for any medication versus 379 (91.1%) of the younger cohort. There was no mortality in both cohorts. The prevalence of delayed facial palsy was 4.8% in the elderly group and 4.1% in the younger group. One (0.5%) patient in the elderly group and 3 (0.7%) patients in the younger group suffered cerebrospinal fluid (CSF) leakage. There was no significant difference between the two groups in terms of MVD-related complications, such as delayed facial palsy, hearing impairment, CSF leakage, and hematoma. CONCLUSIONS: MVD is an effective treatment option in elderly patients with HFS as well as in younger patients. Age itself seems to be no relevant contraindication or, alternatively, risk factor regarding MVD.

Diffuse Large B Cell Lymphoma Presented as Trigeminal Neuralgia: 2 Cases Reported and Literature Review.

BACKGROUND: Extraaxial lymphoma involving the trigeminal nerve, an uncommon condition that presents as a trigeminal schwannoma, resulted in misdiagnosis and a flawed surgical strategy. We report 2 cases: a primary lymphoma of the Meckel cave and a metastasis lymphoma in the prepontine cistern arising from the supraclavicular lymph node. CASE DESCRIPTION: The first patient presented with a 3-month history of persistent, sharp facial pain across the area innervated by the V2 nerve. She was misdiagnosed with primary trigeminal neuralgia and underwent microvascular decompression. Intraoperatively, the trigeminal nerve was swollen to a large extent and surrounded by red granuloma-like tissue. The second case was a 75-year-old woman; she had a history of a malignant lymphoma of the supraclavicular lymph node and presented with right facial pain. Magnetic resonance imaging revealed that the cisternal portion of the right trigeminal nerve was swollen. A specimen was taken from the 2 patients, and histopathologic examinations revealed a diffuse large B cell lymphoma. CONCLUSIONS: The diagnosis of a malignant lymphoma should be considered for lesions in the trigeminal region. Extracting a specimen for biopsy is the most suitable surgical strategy. Our report indicates that postoperative adjuvant chemotherapy for malignant lymphomas is essential.

Surgical Treatment of Secondary Hemifacial Spasm: Long-Term Follow-Up.

BACKGROUND: Hemifacial spasm (HFS) is generally caused by the root exit zone of the facial nerve compressed by an overlying arterial loop. HFS can also be caused by various types of tumor, aneurysm, or arteriovenous malformation. We retrospectively analyzed patients to evaluate possible differences in the demographic and clinical features between primary and secondary HFS. METHODS: A retrospective study of 3140 cases of HFS treated in our department between January 2009 and June 2016. Among the 3140 total cases, 26 patients had secondary HFS. RESULTS: The 26 tumors of secondary HFS included 11 meningiomas, 8 epidermoid cysts, and 7 vestibular schwannomas. Compared to those with idiopathic HFS, those patients with tumor-induced HFS were significantly younger (P < 0.05). Secondary HFS tended to have responsible vessels, and were observed in 20 (76.92%) of these 26 patients. The long-term effective rate of operation was 84% in the secondary HFS group and was 96.45% in the primary HFS group (P < 0.05); the incidence rate of complication was 12% in the secondary HFS group and was 3.06% in the primary HFS group (P < 0.05). CONCLUSIONS: In cases of secondary HFS, facial nerves of most patients were compressed by blood vessels, so microvascular decompression after tumor resection plays an important role. We should examine the entire nerve root for possible vascular compression.

Involved Small Arteries in Patients Who Underwent Microvascular Decompression for Hemifacial Spasm.

BACKGROUND: Microvascular decompression (MVD) has become widely accepted as first-line therapy for hemifacial spasm. However, not all patients are candidates for the procedure, and some surgeons ignore arterioles that represent the actual underlying cause of the condition. The aim of this study was to address the role of involved arterioles in management of MVD in patients with hemifacial spasm. METHODS: Data were collected from 765 consecutive patients who underwent MVD from January 2009 to August 2010 in our hospital. Electromyographic abnormal muscle response and Z-L response were used to identify the involved arterioles. All patients were followed for 25-35 months. RESULTS: Compression by the involved arterioles was identified in 20 patients. The most commonly involved arteriole was a branch of the anterior inferior cerebellar artery, followed by the posterior inferior cerebellar artery. During follow-up, effective outcomes were achieved in 93.6% of patients with involved arterioles. There was no MVD-related mortality. CONCLUSIONS: The main reason for failed MVD is that the involved offending vessel is not correctly identified. Intraoperative abnormal muscle response and Z-L response are good supplementary measures to identify involved arterioles. In addition, not isolating or coagulating the involved arterioles increases the risk associated with the operation.

Evaluation of Microvascular Decompression as Rescue Therapy for Trigeminal Neuralgia in Patients with Failed Gamma Knife Surgery.

OBJECTIVE: Owing to increasing use of Gamma Knife surgery (GKS) for trigeminal neuralgia (TN), physicians are challenged over the problem of choosing an appropriate treatment if GKS fails. The aim of this study was to determine whether microvascular decompression (MVD) is a safe and effective alternative therapy for trigeminal neuralgia in patients with failed GKS. METHODS: Between January 1, 2010, and January 1, 2012, data of 32 patients with trigeminal neuralgia who presented with persistent or recurrent pain after GKS and elected to undergo MVD were collected. Clinical characteristics, operative findings, outcomes of MVD, and complications were reviewed. RESULTS: Mean interval time between GKS and MVD was 16 ± 5.64 months (range, 6-27 months). During MVD, the most common offending vessel was the superior cerebellar artery, followed by the anterior inferior cerebellar artery and vertebral artery. Immediately after MVD, 29 patients (90.63%) experienced complete pain relief without medication. At the end of the follow-up period, 25 patients were pain-free without medication. CONCLUSIONS: Our data confirm that MVD is an effective and safe alternative therapy after GKS, although the risk of facial numbness seems higher in patients with a history of GKS than in patients without a history of GKS.

Management of Primary Bilateral Trigeminal Neuralgia with Microvascular Decompression: 13-Case Series.

BACKGROUND: Bilateral trigeminal neuralgia is a relatively rare disease. Microvascular decompression (MVD) is a safe and effective treatment for unilateral trigeminal neuralgia; however, its utility in bilateral trigeminal neuralgia is unclear. Here, we report our experience with MVD in 13 cases of primary bilateral trigeminal neuralgia. METHODS: We retrospectively analyzed 13 cases of bilateral trigeminal neuralgia that were treated with MVD between January 2013 and January 2015. Surgical outcomes and complications were explored in each case. RESULTS: Postoperatively, 11 patients had excellent outcomes and 2 patients had good outcomes on the operative side. Three patients also reported the amelioration of contralateral symptoms after MVD. Of 10 cases indicating no contralateral improvement, 1 refused to undergo a second MVD procedure on the opposite side and 9 underwent a second MVD procedure and experienced symptom relief. The superior cerebellar artery was the most common offending vessel. There were no severe MVD-related complications. CONCLUSION: Vascular compression plays a causative role in bilateral and unilateral trigeminal neuralgia. MVD appears to be a safe and effective treatment option in patients who are refractory to pharmacotherapy.

Long-Term Efficacy of Initial Microvascular Decompression Versus Subsequent Microvascular Decompression for Idiopathic Hemifacial Spasm.

OBJECTIVE: Hemifacial spasm (HFS) is a disorder characterized by intermittent, involuntary facial muscle contractions. Microvascular decompression (MVD) is the gold treatment for HFS. The aim of this research was to discuss whether patients undergoing MVD as their initial surgical intervention experience greater spasm control than patients experiencing an MVD performed as a subsequent surgical intervention. METHODS: The study included 976 patients with HFS, 452 of whom (group A) underwent MVD as their initial surgical intervention and 524 of whom (group B) underwent subsequent MVD. Relevant clinical data including outcome of MVD, operative findings, complications, and so on were collected immediately after MVD operation and at follow-up. RESULTS: The follow-up period was 7-9 years (mean, 7.96 ± 0.87 years). The mean age at intervention was 53.14 years and 55.43 years in the 2 groups, respectively. The long-term postoperative relief rate of patients in the 2 groups was 98.23% and 87.21%, respectively. There was a significant difference in long-term postoperative relief rate of patients between the 2 groups (P < 0.05). CONCLUSIONS: Patients undergoing MVD for HFS as the primary treatment experience better long-term efficacy than patients first treated with botulinum neurotoxin type A.

The Effects of Combined Intraoperative Monitoring of Abnormal Muscle Response and Z-L Response for Hemifacial Spasm.

BACKGROUND: Microvascular decompression (MVD) is the most effective treatment for hemifacial spasm (HFS). During MVD surgery, abnormal muscle response (AMR) is widely used. Z-L response (ZLR) is a new monitoring method for HFS. We compared the effectiveness of AMR plus ZLR and simple AMR. METHODS: In a retrospective study of 1868 cases of HFS treated using intraoperative monitoring between January 2013 and December 2015, 896 patients underwent simple AMR monitoring and 972 underwent combined intraoperative monitoring of AMR and ZLR. RESULTS: AMR waveforms were observed in 837 (93.42%) patients in the AMR group and in 898 (92.39%) patients in the AMR plus ZLR group (P > 0.05). During MVD, AMR waveforms disappeared in 772 patients in the AMR group and 854 patients in the AMR plus ZLR group (P < 0.05). The efficacy rate of MVD in the AMR plus ZLR group was higher compared with the AMR group when AMR was not detected or disappeared during the operation (P < 0.05). When AMR persisted during the operation, there was no significant difference between the 2 groups in efficacy of the operation (P > 0.05). CONCLUSIONS: Regardless of whether the compression vessels of the facial nerve are simple or complicated, combined intraoperative monitoring of AMR plus ZLR monitoring provides more valuable neurosurgical guidance than simple AMR during MVD for HFS.

Long-Term Efficacy of Nerve Combing for Patients with Trigeminal Neuralgia and Failed Prior Microvascular Decompression.

BACKGROUND: Microvascular decompression (MVD) of the trigeminal nerve is the most effective treatment for trigeminal neuralgia (TN). However, many patients respond poorly to initial MVD. For these patients, redo MVD is commonly done. There has been no research regarding the effectiveness of nerve combing (NC) plus MVD in patients with TN and failed prior MVD. We compared the clinical outcome of NC plus MVD and simple redo MVD in patients with TN and failed prior MVD. METHODS: We performed a retrospective analysis of 148 patients with recurrent or persistent TN symptoms who underwent surgery between January 2007 and December 2015. Simple MVD was performed in 62 patients, and NC plus MVD was performed in 86 patients. RESULTS: For simple MVD, success rates at 1 day, 7 days, 1 month, 3 months, and 1 year after surgery all were approximately 80%. Success rates of NC plus MVD were significantly (P < 0.05) higher than success rates of simple MVD, by 17.02%, 18.64%, 16.47%, 17.21%, and 14.80% at 1 day, 7 days, 1 month, 3 months, and 1 year. The incidence rates of facial numbness in the simple MVD group were 48.39%, 45.16%, 36.67%, 16.95%, and 1.75% at 1 day, 7 days, 1 month, 3 months, and 1 year; the incidence rates in the NC plus MVD group were 60.47%, 55.81%, 48.24%, 21.69%, and 3.75% (P > 0.05). CONCLUSIONS: In patients with TN who failed prior MVD, NC plus MVD significantly improved the success rate of the operation compared with simple redo MVD. We obtained good short-term and long-term surgical outcomes with NC combined with MVD.

Operative Complications of Microvascular Decompression for Hemifacial Spasm: Experience of 1548 Cases.

BACKGROUND: Although microvascular decompression (MVD) surgery is considered the gold standard treatment for hemifacial spasm, there are some MVD-related complications. METHODS: We retrospectively reviewed 1548 patients with hemifacial spasm who underwent retromastoid suboccipital craniectomy with MVD from January 2009 to June 2013. All patients were followed for >2 years. RESULTS: Excellent and good results were 92.5% and 4.2%, respectively. Postoperative complications were recorded in 16.09% (n = 249). There was no MVD-related mortality. After MVD surgery, the most frequent complications were occipital sensory disturbance (7.3%), facial nerve palsy (9.7%), and hearing impairment (3.5%). Other complications were as follows: cerebrospinal fluid leakage (n = 24), poor healing wound (n = 14), lower cranial nerve palsy (n = 12), wound infection (n = 4), and hemorrhage (n = 2). CONCLUSIONS: MVD operation is a safe treatment for hemifacial spasm. Facial nerve palsy is the most common MVD-related complication; preservation of the lesser occipital nerve during MVD surgery can decrease the rate of occipital sensory disturbance. Permanent or serious complications are comparatively rare in MVD surgery.

Surgical Treatment of Hemifacial Spasm Caused by the Compression of Internal Auditory Canal of Facial Nerve.

OBJECTIVE: To make out the way to distinguish the offending vessels compressed the internal auditory canal part of the facial nerve. METHODS: The hemifacial spasm patients were treated of microvascular decompression surgery with neurophysiologic monitoring. The patients were found that the internal auditory canal of the facial nerves was fully compressed, and the records of surgery monitoring were analyzed. RESULTS: All the patients were recorded the delay incubation period in electromyography monitoring, and all patients were hemifacial spasm free finally. CONCLUSION: Some hemifacial spasms were caused by internal auditory canal compression, so during the operation, the authors should explore the whole course of the facial nerve and compress the internal auditory canal part with the aid of neurophysiologic monitoring.

Utility of Brainstem Trigeminal Evoked Potentials in Patients With Primary Trigeminal Neuralgia Treated by Microvascular Decompression.

OBJECTIVE: To investigate the characteristics of brainstem trigeminal evoked potentials (BTEP) waveform in patients with and without trigeminal neuralgia (TN), and to discuss the utility of BTEP in patients with primary TN treated by microvascular decompression (MVD). METHODS: A retrospective review of 43 patients who underwent BTEP between January 2016 and June 2016, including 33 patients with TN who underwent MVD and 10 patients without TN. Brainstem trigeminal evoked potentials characteristics of TN and non-TN were summarized, in particular to compare the BTEP changes between pre- and post-MVD, and to discover the relationship between BTEP changes and surgical outcome. RESULTS: Brainstem trigeminal evoked potentials can be recorded in patients without trigeminal neuralgia. Abnormal BTEP could be recorded when different branches were stimulated. After decompression, the original W2, W3 disappeared and then replaced by a large wave in most patients, or original wave poorly differentiated improved in some patients, showed as shorter latency and (or) amplitude increased. Brainstem trigeminal evoked potentials waveform of healthy side in patients with trigeminal neuralgia was similar to the waveform of patients without TN. In 3 patients, after decompression the W2, W3 peaks increased, and the latency, duration, IPLD did not change significantly. Until discharge, 87.9% (29/33) of the patients presented complete absence of pain without medication (BNI I) and 93.9% (31/33) had good pain control without medication (BNI I-II). CONCLUSION: Brainstem trigeminal evoked potentials can reflect the conduction function of the trigeminal nerve to evaluate the functional level of the trigeminal nerve conduction pathway. The improvement and restoration of BTEP waveforms are closely related to the postoperative curative effect.

Results of Atypical Hemifacial Spasm with Microvascular Decompression: 14 Case Reports and Literature Review.

BACKGROUND: Few studies have examined atypical hemifacial spasm (AHFS), and the mechanism of AHFS remains unclear. In this study, we examined the etiology, prognosis, and treatment of AHFS. METHODS: We retrospectively analyzed the clinical data for 14 consecutive patients that underwent microvascular decompression (MVD) for AHFS between January 2014 and December 2015. Clinical features, outcomes, and complications were evaluated. RESULTS: The incidence of AHFS is 1.52%. There were no significant differences in sex, age, side and duration between the typical hemifacial spasm and AHFS. During the follow-up period, the effective rate of MVD for patients with AHFS was 92.3%. Three patients developed delayed facial nerve palsy postoperatively, 1 patient experienced occipital sensory disturbance, and 1 patient suffered hearing loss. CONCLUSIONS: Most of the cases of AHFS studied here were caused by neurovascular conflict in zone IV of the facial nerve distal to the root entry zone. MVD surgery is the first choice treatment for AHFS.

Electromyographically Guided Nerve Combing Makes Microvascular Decompression More Successful in Hemifacial Spasm with Persistent Abnormal Muscle Response.

BACKGROUND: Microvascular decompression (MVD) of the facial nerve monitored intraoperatively by abnormal muscle response (AMR) activity is a common treatment for hemifacial spasm. AMR frequently persists after MVD, however, for which electromyography (EMG)-guided nerve combing sometimes is recommended. Because no research regarding the success of EMG-guided nerve combing has been published, we compared the effectiveness of nerve combing after MVD with simple MVD in cases including persistent AMR. METHODS: A retrospective study of 127 cases of hemifacial spasm treated with persistent AMR after MVD treatment occurring between January 2011 and June 2015 was conducted. Among the 127 total cases, EMG-guided nerve combing was used in 72 patients and simple MVD in 55 patients. RESULTS: For simple MVD, success rates at 1 day, 7 days, 1 month, 3 months, and 1 year after surgery were all approximately 80%; the success rates of MVD with nerve combing were significantly greater (P < 0.05) than those of simple MVD, by 15.83%, 15.4%, 17.22%, 17.65%, and 17.65%, respectively. The incidence rates of facial palsy in simple MVD were 12.73%, 14.55%, 10.91%, 3.64%, and 1.82%, respectively; those in the nerve combing group were 27.78% (P < 0.05 vs. simple MVD), 33.33% (P < 0.05), 25.00% (P = 0.05), 5.55% (P > 0.05), and 2.78% (P > 0.05), respectively. CONCLUSIONS: In cases of hemifacial spasm with persistent AMR after MVD, EMG-guided nerve combing significantly improved the success rate of the operation. Although it also significantly increased the incidence of postoperative facial palsy over the short term (up to 1 week), incidences in the long term were not significantly different.

Microvascular Decompression for Glossopharyngeal Neuralgia: Long-Term Follow-Up.

OBJECTIVE: To examine operative findings and outcome of microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN). This research displayed the long-term outcomes of a large series of 35 cases with GPN treated with MVD. METHODS: From January 2004 to June 2006, 35 consecutive patients were diagnosed with GPN. All of them underwent MVD. Demographic data, clinical presentation, operative findings, clinical results, operative complications were reviewed. RESULTS: A total of 33 patients (94.3%) experienced complete pain relief immediately after MVD. Long-term follow-up was available for 30 of these 35 patients, and 28 of these 30 patients continued to be pain-free. There was no long-term operative morbidity in all cases. One patient had a cerebrospinal fluid leak and 1 case presented with delayed facial palsy. CONCLUSIONS: Classic GPN is usually caused by pulsatile neurovascular compression of the glossopharyngeal and vagus rootlets. MVD is a safe, effective, and durable operation for GPN.

The Effects of Dual Abnormal Muscle Response Monitoring on Microvascular Decompression in Patients with Hemifacial Spasm.

BACKGROUND: Microvascular decompression (MVD) is the most useful treatment for hemifacial spasm (HFS). During MVD surgery, traditional abnormal muscle response (tAMR) is widely used to monitor success in decompressing the facial nerve. Dual AMR (dAMR) is a new monitoring method used during MVD for HFS. We compared the sensitivities and reliabilities of tAMR and dAMR. METHODS: We performed a retrospective study of 1301 cases of HFS treated using MVD between January 2014 and March 2016. Among the 1301 cases, 587 patients underwent tAMR monitoring and 714 underwent dAMR monitoring. RESULTS: Typical abnormal muscle response (AMR) waveforms were observed in 484 patients (82.5%) in the tAMR group and in 688 patients (96.4%) in the dAMR group (P < 0.05). AMR waveforms disappeared in 459 patients in the tAMR group and in 655 patients in the dAMR group during MVD. One day, 7 days, 1 month, and 3 months after MVD surgeries with AMR disappearance, the effective rate of MVD was 95.0%, 94.3%, 94.5%, and 95.0%, respectively, in the tAMR group. The corresponding rates were 97.7%, 96.9%, 97.3%, and 98.0% in the dAMR group (P < 0.05). One day, 7 days, 1 month, and 3 months after MVD surgeries with AMR persistence, the effective rate of MVD was 68.0%, 64.0%, 64.0%, and 64.0%, respectively, in the tAMR group. The corresponding rates were 90.9%, 87.9%, 87.9%, and 90.9% in the dAMR group (P < 0.05). CONCLUSIONS: AMR monitoring provides valuable neurosurgical guidance during MVD for HFS. dAMR monitoring has better sensitivity and reliability than tAMR monitoring.

Bell's Palsy: Clinical Analysis of 372 Cases and Review of Related Literature.

OBJECTIVE: To analyze some clinical and epidemiologic aspects of Bell's palsy (BP) and to develop relevant correlations between existing data in literature and those obtained in this research. METHODS: From January 2012 to December 2014, 372 consecutive patients diagnosed with BP were studied retrospectively. We reviewed the patients' data including gender, age, occupation, clinical manifestations, comorbid disease, and the rate of recurrence. RESULT: The highest incidence was identified in those between 39 and 50 years of age. BP was more frequent in warm seasons (spring and summer) with its incidence reaching a peak value in September. The seasonal incidence of BP was significantly higher in summer (p < 0.05). In addition, diabetes mellitus was the most common accompanying comorbid condition. CONCLUSION: The peak age when BP showed up was in the fourth decade of life and 55.1% of patients belonged to the male gender. BP has been observed to have the highest incidence during warm seasons (spring and summer). Diabetes mellitus was the most common comorbid condition accompanying BP. In addition, a recurrence was more likely to occur in the first 1.5 years after its first incidence.

Factors Promoting a Good Outcome in a Second Microvascular Decompression Operation When Hemifacial Spasm is Not Relieved After the Initial Operation.

BACKGROUND: Microvascular decompression (MVD) has become the best treatment for hemifacial spasm (HFS); however, some patients do not obtain complete relief after the initial MVD. We analyzed a group of patients who underwent a second MVD, to identify the factors that prevented relief after the initial MVD and those that promote the success of the second procedure. METHODS: Of a group of 1400 patients with typical primary unilateral HFS treated with MVD between January 2014 and October 2015, we focused on 42 patients with poor postoperative outcomes. All patients underwent abnormal muscle response (AMR) monitoring again the day after surgery. Of those patients, 35 underwent a second MVD surgery within a week. We analyzed their AMRs after each operation. RESULTS: After the first operation, AMR was positive in 40 patients and negative in 2 patients. The latter 2 patients reported spontaneous relief within 1 week. Among the 40 positive patients, 35 and 4 patients underwent a second MVD within a week and 6-11 months, respectively. Thirty-nine patients reported relief after the second MVD; 1 patient remained unchanged at follow-up (<12 months). CONCLUSIONS: When initial MVD does not provide relief, a repeat MVD should be performed as soon as possible. In 2/42 cases, relief was delayed enough that AMR had a false-negative result. Combinative monitoring of AMR and Z-L responses was important in identifying the real cause of HFS.

Management of vessels passing through the facial nerve in the treatment of hemifacial spasm.

BACKGROUND: In hemifacial spasm, it is extremely rare to find a vessel passing through the facial nerve. In this study, we present our experience of the surgical treatment of four such patients. METHODS: From January 2010 to Match 2015, we treated 2,576 hemifacial spasm patients with microvascular decompression in our department. Of these, four had an intraneural vessel. Intraoperative findings and treatment were recorded, and postoperative outcomes were analyzed. RESULTS: In three patients, the intraneural vessel was the anterior inferior cerebellar artery, which we wrapped with small pieces of wet gelatin and Teflon sponge. A small vein found in the fourth patient was treated with facial nerve combing. Complete decompression was achieved and abnormal muscle response disappeared. Three patients got an excellent result and one patient got a good result. One patient had postoperative facial paralysis, which improved over 10 months of follow-up. CONCLUSION: If an artery passes through the facial nerve, it can be decompressed by wrapping the vessel with wet gelatin and Teflon sponge. If a vein passes through the facial nerve, combing can be used. Intraoperative abnormal muscle response monitoring is very helpful in achieving complete decompression.

Nimodipine-mediated re-myelination after facial nerve crush injury in rats.

This study aimed to investigate the mechanism of nimodipine-mediated neural repair after facial nerve crush injury in rats. Adult Sprague-Dawley rats were divided into three groups: healthy controls, surgery alone, and surgery plus nimodipine. A facial nerve crush injury model was constructed. Immediately after surgery, the rats in the surgery plus nimodipine group were administered nimodipine, 6 mg/kg/day, for a variable numbers of days. The animals underwent electromyography (EMG) before surgery and at 3, 10, or 20 days after surgery. After sacrifice, nerve samples were stained with hematoxylin and eosin (H&E) and luxol fast blue. The EMG at 20 days revealed an apparent recovery of eletroconductivity, with the surgery plus nimodipine group having a higher amplitude and shorter latency time than the surgery only group. H&E staining showed that at 20 days, the rats treated with nimodipine had an obvious recovery of myelination and reduction in the number of infiltrating cells, suggesting less inflammation, compared with the rats in the surgery only group. Luxol fast blue staining was relatively even in the surgery plus nimodipine group, indicating a protective effect against injury-induced demyelination. Staining for S100 calcium-binding protein B (S-100ß) was not evident in the surgery alone group, but was evident in the surgery plus nimodipine group, indicating that nimodipine reversed the damage of the crush injury. After a facial nerve crush injury, treatment with nimodipine for 20 days reduced the nerve injury by mediating remyelination by Schwann cells. The protective effect of nimodipine may include a reduction of inflammation and an increase in calcium-binding S-100ß protein.