Microvascular decompression for hemifacial spasm involving the vertebral artery

Abstract Objective Microvascular decompression (MVD) has become an accepted treatment modality for the vertebral artery (VA)–involved hemifacial spasm (HFS). The aim of this retrospective study was to evaluate clinical and surgical outcomes of HFS patients undergoing MVD and surgical and cranial nerve complications and investigate reasonable transposition procedures for two different anatomic variations of VA. Methods Between January and December 2018, 109 patients underwent first MVD for HFS involving VA at Nanjing Drum Tower Hospital. Based on whether the VA could be moved ventrally at the lower cranial nerves (LCNs) level, patients were assigned to Group A (movable VA, n = 72) or B (unmovable VA, n = 37), and clinical and surgical outcomes and complications on the day of post-surgery and during follow-up were assessed. All patients were followed up ranging from 17 to 24 months with a mean follow-up period of 21 months. Results After a mean follow-up of 21 months, the total cure rate significantly decreased in all patients compared to that achieved on the day of surgery, and Group A patients exhibited a higher cure rate versus Group B (93.1% vs. 75.7%, P = 0.015). Group B patients with unmovable VA revealed both higher incidence of surgical complications (45.9% vs. 15.3%, P = 0.001) and frequency of bilateral VA compression (27% vs. 8.3%, P = 0.009) versus Group A. No significant difference was observed in long-term cranial nerve complications. Conclusions VA-involved HFS can benefit from MVD strategies after preoperative assessment of VA compression. HFS patients with movable VA may receive better long-term efficacy and fewer complications. A Teflon bridge wedged between the distal VA and medulla gives rise to adequate space for decompression surgery.

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Persistent abnormal muscle response after microvascular decompression for hemifacial spasm

Scientific Reports ◽

10.1038/s41598-020-75742-x ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Li Xu ◽

Wu Xu ◽

Jing Wang ◽

Yulong Chong ◽

Weibang Liang ◽

...

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Duration Of Symptoms ◽

Long Term Outcome ◽

Muscle Response ◽

Abnormal Muscle Response ◽

Significant Difference ◽

Group A ◽

Group B

Abstract To explore the causes of persistent abnormal muscle response (AMR) after microvascular decompression (MVD) for hemifacial spasm (HFS) and the clinical outcomes of these patients. MVDs performed in Nanjing Drum Tower Hospital in 2017 were retrospectively studied, and 326 patients with HFS were classified into two groups based on whether AMR disappeared or persisted following MVD. The clinical features, treatment efficacy and postoperative complications were compared between the two groups. 305 patients with disappeared AMR after decompression were classified as Group A. In Group B, the 21 patients exhibited persistent AMR after successful MVD. The preoperative duration of symptoms in Group B was significantly longer than that in Group A (P < 0.001), and no significant difference was identified between the two groups in terms of gender, side, age and offending vessels (P > 0.05). The immediate postoperative cure rate of Group A (88.9%)was significantly higher than that in Group B (28.6%, P < 0.001), furthermore, the two groups were not different in the long-term outcome and the incidence of surgical complications (P > 0.05). The long preoperative duration of HFS patients may account for persistent AMR after successful decompression, and it is more likely for these patients to get delayed cured, the long-term outcomes showed no difference compared to those in patients with disappeared AMR after MVD.

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Prognostic ability of intraoperative electromyographic monitoring during microvascular decompression for hemifacial spasm to predict lateral spread response outcome

Journal of Neurosurgery ◽

10.3171/2016.1.jns151782 ◽

2017 ◽

Vol 126 (2) ◽

pp. 391-396 ◽

Cited By ~ 9

Author(s):

Sung Ho Lee ◽

Bong Jin Park ◽

Hee Sup Shin ◽

Chang Kyu Park ◽

Bong Arm Rhee ◽

...

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Prognostic Value ◽

University Hospital ◽

Lateral Spread ◽

Symptom Duration ◽

Group A ◽

Lateral Spread Response ◽

Group B

OBJECTIVE Abnormal lateral spread response (LSR) is a typical finding in facial electromyography (EMG) in patients with hemifacial spasm (HFS). Although intraoperative monitoring of LSR has been widely used during microvascular decompression (MVD), the prognostic value of this monitoring is still debated. The purpose of this study was to determine whether such monitoring exhibits prognostic value for the alleviation of LSR after treatment of HFS. METHODS Between January 2009 and December 2013, a total of 582 patients underwent MVD for HFS with intraoperative EMG monitoring at Kyung Hee University Hospital. The patients were categorized into 1 of 2 groups according to the presence of LSR at the conclusion of surgery (Group A, LSR free; Group B, LSR persisting). Patients were assessed for the presence of HFS 1 day, 6 months, and 1 year after surgery. Various parameters, including age, sex, symptom duration, offending vertebral artery, and offending perforating artery, were evaluated for their influence on surgical and electrophysiological results. RESULTS Overall, HFS was alleviated in 455 (78.2%) patients 1 day after MVD, in 509 (87.5%) patients 6 months after MVD, and in 546 (93.8%) patients 1 year after MVD. Patients in Group B were significantly younger than those in Group A (p = 0.022). Patients with a symptom duration of less than 1 year were significantly more likely to be classified in Group A than were patients whose symptoms had persisted for longer than 10 years (p = 0.023); however, analysis of the entire range of symptom durations did not reveal a significant effect (p = 0.132). A comparison of Groups A and B according to follow-up period revealed that HFS recovery correlated with LSR alleviation over a shorter period, but the same was not true of longer periods; the proportions of spasm-free patients were 80.6% and 71.1% (p = 0.021), 89.4% and 81.9% (p = 0.022), and 93.5% and 94.6% (p = 0.699) 1 day, 6 months, and 1 year after surgery in Groups A and B, respectively. CONCLUSIONS Although intraoperative EMG monitoring during MVD was beneficial for identifying the offending vessel and suggesting the most appropriate surgical end point, loss of LSR did not always correlate with long-term HFS treatment outcome. Because the HFS cure rate improved over time, revision might be considered for persistent LSR when follow-up has been performed for more than 1 year and the spasm remains despite adequate decompression.

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Cerebellopontine Angle Epidermoids Presenting with Cranial Nerve Hyperactive Dysfunction: Pathogenesis and Long-term Surgical Results in 30 Patients

Neurosurgery ◽

10.1097/00006123-200202000-00008 ◽

2002 ◽

Vol 50 (2) ◽

pp. 276-286 ◽

Cited By ~ 4

Author(s):

Hitoshi Kobata ◽

Akinori Kondo ◽

Koichi Iwasaki

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Cranial Nerve ◽

Cerebellopontine Angle ◽

Cranial Nerves ◽

Clinical Manifestations ◽

Surgical Results ◽

Neurovascular Structures

ABSTRACT OBJECTIVE To provide the characteristics and long-term surgical results of patients who present with cerebellopontine angle epidermoids and trigeminal neuralgia (TN) or hemifacial spasm. METHODS A total of 30 patients (23 women, 7 men) who presented with cerebellopontine angle epidermoids and TN (28 patients) or hemifacial spasm (2 patients) between 1982 and 1995 were reviewed, with emphasis being placed on the clinical manifestations, the mechanisms of symptom development, the long-term follow-up results, and the anatomic relationship between the tumor and the surrounding neurovascular structures. RESULTS The average age of the patients was 37.8 years at symptom onset and 49.3 years at the time of the operation. The tumor-nerve relationships were classified into four types: complete encasement of the nerve by the tumor, compression and distortion of the nerve by the tumor, compression of the nerve by an artery located on the opposite side of the unilateral tumor, and compression of the nerve by an artery on the same side of the tumor. Total resection was achieved in 17 patients (56.7%). Microvascular decompression of the respective cranial nerve was achieved in nine cases of direct arterial compression in addition to tumor removal. The symptom was relieved completely in all cases. In an average follow-up period of 11.5 years, three patients developed recurrent symptoms: two experienced tumor regrowth, and one had arachnoid adhesion. CONCLUSION Hyperactive dysfunction of the cranial nerves, especially TN, may be the initial and only symptom that patients with cerebellopontine angle epidermoids experience. The occurrence of TN at a younger age was characteristic of TN patients with epidermoids, in contrast to patients with TN due to a vascular cause. The symptom is elicited by compression of the nerve by the tumor per se, by an artery that is displaced to the nerve, or by both. Careful resection of the tumor, whose capsule occasionally is strongly adherent to the neurovascular structures, is necessary, and microvascular decompression to straighten the neuraxis should be performed in some cases to achieve a complete, permanent cure of symptoms with a low rate of recurrence.

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Prognostic value of lateral spread response during microvascular decompression for hemifacial spasm

Journal of International Medical Research ◽

10.1177/0300060519839526 ◽

2019 ◽

Vol 47 (12) ◽

pp. 6120-6128

Author(s):

Hongmei Song ◽

Songbai Xu ◽

Xiushuang Fan ◽

Mingxin Yu ◽

Jiachun Feng ◽

...

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Surgical Outcomes ◽

Prognostic Value ◽

Prognostic Indicator ◽

Lateral Spread ◽

Short Term ◽

Group A ◽

Lateral Spread Response

Objective This study aimed to investigate the prognostic value of the lateral spread response (LSR) for predicting surgical outcomes following microvascular decompression (MVD) in patients with hemifacial spasm. Methods Seventy-three patients with hemifacial spasm underwent MVD with intraoperative LSR monitoring. Surgical outcomes were evaluated 1 week and 1 year after MVD and correlations between LSR characteristics and surgical outcomes were analyzed. Results The LSR disappeared completely in 61 patients during surgery (Group A; prior to insertion of Teflon felt pledgets in 11, after insertion of pledgets in 50), disappeared partially in nine patients (Group B), and remained unchanged in three patients (Group C). Fifty-five patients showed short-term and 61 patients showed long-term clinical cures during the follow-up period. The short-term and long-term cure rates were significantly higher in Group A than in Group C. There was no correlation between the time of complete LSR disappearance and surgical outcomes. Conclusions Disappearance of the LSR during MVD is correlated with the surgical outcomes. Intraoperative LSR monitoring is a reliable approach for predicting the prognosis of hemifacial spasm following MVD, but the time at which LSR disappears is not a prognostic indicator.

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Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

Reviews on Recent Clinical Trials ◽

10.2174/1574887114666190201111332 ◽

2019 ◽

Vol 14 (2) ◽

pp. 141-146

Author(s):

Simone Zanella ◽

Enrico Lauro ◽

Francesco Franceschi ◽

Francesco Buccelletti ◽

Annalisa Potenza ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

The Elderly ◽

Long Term Follow Up ◽

Group A ◽

Group B ◽

Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

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439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes

British Journal of Surgery ◽

10.1093/bjs/znab134.280 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Durity ◽

G Elliott ◽

T Gana

Keyword(s):

Complicated Diverticulitis ◽

Complication Rates ◽

Long Term Outcomes ◽

Female Ratio ◽

Stoma Reversal ◽

Group A ◽

Grade 3 ◽

Group B

Abstract Introduction Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management. Method We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017. Results Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s. Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%). Conclusions In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.

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The Role of Quantic Molecular Resonance (QMR) in the Treatment of Inferior Turbinate Hypertrophy (ITH): Our Experience With Long-Term Follow-Up in Allergic and Nonallergic Rhinitis Refractory to Medical Therapy. Preliminary Results

Ear Nose & Throat Journal ◽

10.1177/01455613211001599 ◽

2021 ◽

pp. 014556132110015

Author(s):

Filippo Ricciardiello ◽

Davide Pisani ◽

Pasquale Viola ◽

Raul Pellini ◽

Giuseppe Russo ◽

...

Keyword(s):

Nasal Obstruction ◽

Inferior Turbinate ◽

Nonallergic Rhinitis ◽

Turbinate Hypertrophy ◽

Group A ◽

Group B ◽

Inferior Turbinate Hypertrophy ◽

Molecular Resonance

Objective: The aim of this study was to assess the long-term effectiveness of quantic molecular resonance (QMR) in the treatment of inferior turbinate hypertrophy (ITH) in allergic and nonallergic rhinitis refractory to medical therapy. Methods: This study enrolled 281 patients, 160 males (56.9%) and 121 females (43.1%), mean age 37.8 ± 4.1 years, range 18 to 71. Fifty-four patients have been lost to follow up and have been therefore excluded from the final analysis. Based on skin prick test results, 69 patients were considered allergic (group A) and 158 nonallergic (group B). All subjects underwent before surgery (T0) and 3 (T1), 12 (T2), 24 (T3), and 36 months (T4) after QMR treatment to: 4-phase rhinomanometric examination, nasal endoscopy evaluation, and visual analogue scale to quantify the subjective feelings about nasal obstruction. Results: Subjective and objective parameters showed statistically significant improvement in both groups. Group B parameters not changed during follow-up, while group A showed significant worsening between T1 and subsequent assessments. T4 outcome indicates a better result in nonallergic patients. Conclusions: In accordance with the literature, our preliminary data validate QMR treatment as a successful therapeutic option for nasal obstruction due to ITH. Nonallergic patients had a very good T4 outcome. Allergic patients showed a worsening trend after 1 year probably due to other causes.

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Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

Journal of Neurosurgery Spine ◽

10.3171/2021.9.spine21822 ◽

2021 ◽

pp. 1-11

Keyword(s):

Scale Score ◽

Neck Disability Index ◽

Implant Removal ◽

Odontoid Fractures ◽

Significant Difference ◽

Flexion Extension ◽

Group A ◽

Group B

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

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Low-voltage-area ablation in paroxysmal atrial fibrillation: Extended follow-up results of the VOLCANO trial

10.22541/au.161661216.67499040/v1 ◽

2021 ◽

Author(s):

Masaharu Masuda ◽

Mitsutoshi Asai ◽

Osamu Iida ◽

Shin Okamoto ◽

Takayuki Ishihara ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Low Voltage ◽

Recurrence Rates ◽

Group A ◽

C 32 ◽

Group B ◽

Group D

Introduction: The randomized controlled VOLCANO trial demonstrated comparable 1-year rhythm outcomes between patients with and without ablation targeting low-voltage areas (LVAs) in addition to pulmonary vein isolation among paroxysmal atrial fibrillation (AF) patients with LVAs. To compare long-term AF/atrial tachycardia (AT) recurrence rates and types of recurrent-atrial-tachyarrhythmia between treatment cohorts during a > 2-year follow-up period. Methods: An extended-follow-up study of 402 patients enrolled in the VOLCANO trial with paroxysmal AF, divided into 4 groups based on the results of voltage mapping: Group A, no LVA (n=336); group B, LVA ablation (n=30); group C, LVA presence without ablation (n=32); and group D, incomplete voltage map (n=4). Results: At 25 (23, 31) months after the initial ablation, AF/AT recurrence rates were 19% in group A, 57% in group B, 59% in group C, and 100% in group D. Recurrence rates were higher in patients with LVAs than those without (group A vs. B+C, p<0.0001), and were comparable between those with and without LVA ablation (group B vs. C, p=0.83). Among patients who underwent repeat ablation, ATs were more frequently observed in patients with LVAs (Group B+C, 50% vs. A, 14%, p<0.0001). In addition, LVA ablation increased the incidence of AT development (group B, 71% vs. C, 32%, p<0.0001), especially biatrial tachycardia (20% vs. 0%, p=0.01). Conclusion: Patients with LVAs demonstrated poor long-term rhythm outcomes irrespective of LVA ablation. ATs were frequently observed in patients with LVAs, and LVA ablation might exacerbate iatrogenic ATs.

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Efficacy of Endoscopic Posterior Nasal Neurectomy in Treating Eosinophilic Chronic Rhinosinusitis

ORL ◽

10.1159/000519724 ◽

2021 ◽

pp. 1-5

Author(s):

Manman Chen ◽

Ming Xu ◽

Xuefeng Lei ◽

Bin Zhang

Keyword(s):

Chronic Rhinosinusitis ◽

Surgical Recurrence ◽

Eosinophilic Chronic Rhinosinusitis ◽

Group A ◽

Sinonasal Outcome Test ◽

Random Number Table ◽

Group B

Objectives: Recent guidelines have revealed that eosinophilic chronic rhinosinusitis (ECRS) exhibits a strong tendency for recurrence after surgery and impairs quality of life. Neuropeptides play an important neuroimmunological role. The aim of this study was to determine the efficacy of posterior nasal neurectomy (PNN) for the treatment of ECRS by inhibiting type 2 cytokine expression. Methods: Forty-six patients were divided into group A and group B according to a random number table. Group A underwent conventional functional endoscopic sinusitis surgery (FESS) combined with PNN, and group B underwent conventional FESS alone. The subjective and objective symptoms included a 10-cm visual analog scale (VAS), 22-item SinoNasal Outcome Test (SNOT-22) score, nasal speculum Lund-Kennedy score, and paranasal sinus computed tomography (CT) Lund-Mackay score at the 1-year postoperative follow-up. Results: Postoperative VAS (10.33 ± 2.18 vs. 8.38 ± 2.11, p < 0.01) and Lund-Kennedy score (1.95 ± 1.32 vs. 3.14 ± 1.35, p < 0.01) were significantly improved. The rhinorrhea score (1.76 ± 0.83 vs. 2.90 ± 1.14, p < 0.001) in the VAS and the discharge (0.43 ± 0.51, vs. 0.95 ± 0.67, p < 0.01) and edema (0.57 ± 0.60 vs. 0.95 ± 0.59, p < 0.05) scores in the Lund-Kennedy score were observed to have improved significantly in group A compared with those in group B. Conclusions: FESS combined with PNN suppresses edema symptoms, which might significantly decrease the surgical recurrence rate of ECRS in the long term.

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