Evaluating Transient Hemifacial Spasm that Reappears After Microvascular Decompression Specifically Focusing on the Real Culprit Location of Vascular Compression

Diseases of ephaptic transmission are commonly caused by vascular compression of cranial nerves. The advent of microvascular decompression has allowed for surgical intervention for this patient population. This chapter highlights the technique of endoscopic-assisted microvascular decompression for trigeminal neuralgia and hemifacial spasm. Endoscopy and keyhole techniques have resulted in a minimally invasive and effective treatment of symptoms for patients with neuralgia.

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Microvascular decompression for hemifacial spasm

Journal of Neurosurgery ◽

10.3171/jns.1991.75.3.0388 ◽

1991 ◽

Vol 75 (3) ◽

pp. 388-392 ◽

Cited By ~ 45

Author(s):

Shinji Nagahiro ◽

Akira Takada ◽

Yasuhiko Matsukado ◽

Yukitaka Ushio

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Posterior Inferior Cerebellar Artery ◽

Cranial Nerves ◽

Anterior Inferior Cerebellar Artery ◽

Vascular Compression ◽

Content Type ◽

Seventh Cranial Nerve ◽

Cerebellar Artery

✓ To determine the causative factors of unsuccessful microvascular decompression for hemifacial spasm, the follow-up results in 53 patients were assessed retrospectively. The mean follow-up period was 36 months. There were 32 patients who had compression of the seventh cranial nerve ventrocaudally by an anterior inferior cerebellar artery (AICA) or a posterior inferior cerebellar artery. Of these 32 patients, 30 (94%) had excellent postoperative results. Of 14 patients with more severe compression by the vertebral artery, nine (64%) had excellent results, three (21%) had good results, and two (14%) had poor results; in this group, three patients with excellent results experienced transient spasm recurrence. There were seven patients in whom the meatal branch of the AICA coursed between the seventh and eighth cranial nerves and compressed the dorsal aspect of the seventh nerve; this was usually associated with another artery compressing the ventral aspect of the nerve (“sandwich-type” compression). Of these seven patients, five (71%) had poor results including operative failure in one and recurrence of spasm in four. The authors conclude that the clinical outcome was closely related to the patterns of vascular compression.

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Hypertension of neurogenic origin: effect of microvascular decompression of the CN IX-X root entry/exit zone and ventrolateral medulla on blood pressure in a prospective series of 48 patients with hemifacial spasm associated with essential hypertension

Journal of Neurosurgery ◽

10.3171/2014.12.jns141775 ◽

2015 ◽

Vol 123 (6) ◽

pp. 1405-1413 ◽

Cited By ~ 15

Author(s):

Marc Sindou ◽

Mohamed Mahmoudi ◽

Andrei Brînzeu

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

High Resolution ◽

Medical Treatment ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Ventrolateral Medulla ◽

Vascular Compression ◽

Who Grade

OBJECT In spite of solid anatomical and physiological arguments and the promising results of Jannetta in the 1970s, treating essential hypertension by microvascular decompression (MVD) of the brainstem has not gained acceptance as a mainstream technique. The main reason has been a lack of established selection criteria. Because of this, the authors' attempts have been limited to patients referred for MVD for hemifacial spasm (HFS) who also had hypertension likely to be related to neurovascular compression (NVC). METHODS Of 201 patients referred for HFS, 48 (23.8%) had associated hypertension. All had high-resolution MR images that demonstrated NVC. All underwent MVD of the root exit/entry zone (REZ) of the ninth and tenth cranial nerves (CN IX-X) and adjacent ventrolateral medulla in addition to the CN VII REZ. Effects on hypertension, graded using the WHO classification, were studied up to the latest follow-up, which was 2–16 years from the time of surgery, 7 years on average. Also, effects of MVD on blood pressure (BP) according to the side of vascular compression were evaluated. RESULTS Preoperatively, hypertension was severe in all but 1 of the patients; in spite of medical treatment, 47 patients still had WHO Grade 1 or 2 hypertension, and 18 still had unstable BP. After MVD, at latest follow-up, BP had returned to normal (i.e., systolic pressure < 140 mm Hg) in 28 patients; 14 of these patients (29.10% of the whole series) were able to maintain normal BP without any antihypertensive treatment; the other 14 still required some medication to maintain their BP below 140 mm Hg (p < 0.0001). Also, at latest follow-up, BP remained unstable in only 8 of the 18 patients with instability prior to MVD (p < 0.02). Analysis according to side of compression showed that of the 30 patients with left-sided compression, 17 had their BP normalized (without medication in 11 cases), and of the 18 patients with right-sided compression, 11 had their BP normalized (without medication in 3 cases). The difference between sides was not significant. CONCLUSIONS These results argue for considering MVD for the treatment of hypertension likely to be due to NVC at the CN IX-X REZ and adjacent ventrolateral medulla. Criteria for selecting patients with hypertension alone still need to be established and could include the following indications: apparently essential hypertension, likely to be neurogenic, in patients in whom high-resolution MRI shows clear-cut images of NVC at the CN IX-X REZ and adjacent ventrolateral medulla and in whom BP cannot be controlled by medical treatment.

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Microvascular Decompression in Patient With Atypical Features of Hemifacial Spasm Secondary to Compression by a Tortuous Vertebrobasilar System

Neurosurgery ◽

10.1227/01.neu.0000369518.49077.d7 ◽

2010 ◽

Vol 66 (6) ◽

pp. E1212-E1212 ◽

Cited By ~ 7

Author(s):

David H. Perlmutter ◽

Anthony L. Petraglia ◽

Richard Barbano ◽

Jason M. Schwalb

Keyword(s):

Hearing Loss ◽

Botulinum Toxin ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Cranial Nerves ◽

Vascular Compression ◽

Vertebrobasilar System ◽

The Face ◽

Grade 3 ◽

The Right

Abstract OBJECTIVE We report a case of hemifacial spasm in a patient who had associated hearing loss, numbness throughout the face, tinnitus, and vertigo, all of which occurred when turning his head to the left. To our knowledge, these symptoms have not occurred in this pattern and with a single trigger. CLINICAL PRESENTATION A 45-year-old man presented with a 3-year history of right-sided hemifacial spasm initially treated with botulinum toxin. One month before presentation, he had an episode of acute hearing loss in the right ear when turning his head to the left, followed by multiple episodes of transient hearing loss in his right ear, numbness in his right face in all distributions of the trigeminal nerve, tinnitus, and vertigo. He was found to have decreased sensation in nerves V1 to V3 and House-Brackmann grade 3/6 weakness in his right face, despite not having botulinum toxin injections in more than a year. Magnetic resonance imaging/angiography showed an ectatic vertebrobasilar system causing compression of the fifth, seventh, and eighth cranial nerves. INTERVENTION The patient underwent a retromastoid craniotomy and microvascular decompression. Postoperatively, he had complete resolution of his symptoms except for his facial weakness. The benefit has been long-lasting. CONCLUSION Multiple, simultaneous cranial neuropathies from vascular compression are rare, but this case is an example of safe and effective treatment with microvascular decompression with durable results.

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219 A Clinical Analysis on Microvascular Decompression Surgery for Treatment of Hemifacial Spasm: 2500 Cases Review in a Single Institute

Neurosurgery ◽

10.1093/neuros/nyx417.219 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 259-260

Author(s):

Myeongki Yeo ◽

Bong Jin Park ◽

Hridayesh Pratap Malla ◽

Bong Arm Rhee ◽

Young Jin Lim

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Clinical Analysis ◽

Postoperative Outcomes ◽

Cerebrospinal Fluid Leakage ◽

Subdural Hemorrhage ◽

Decompression Surgery ◽

Vascular Compression ◽

Root Exit Zone ◽

Microvascular Decompression Surgery

Abstract INTRODUCTION Hemifacial spasm (HFS) is caused by vascular compression of the facial nerve at its root exit zone from the brainstem. Microvascular decompression (MVD) is the only treatment option that offers the prospect of a definitive cure for HFS. However, this surgery can be risky and the postoperative outcomes might not be good enough sometimes. In order to refine that, we investigated our result of MVDs. METHODS Among 2500 consecutive cases of MVDs have been performed in our institute between January 2000 and December 2015, 2196 patients were enrolled in the current study. They were retrospectively analyzed with emphasis on postoperative outcomes and complications. RESULTS >Postoperatively, the spasm complete cease occurred immediately in 73.4%. The symptoms improved at some degree in 22.7%. The spasm not improved at all in 3.9%. However, the symptom free rate was 88.3% at 6 months after surgery. Eventually, the successful rate was increased by 93.1% at 1 year after MVD. Major complications included permanent hearing disturbance (1.13%), permanent facial palsy (0.4%), vertebral artery injury (0.2%), subdural hemorrhage (0.2%), and epidural hemorrhage (0.1%). Minor complications included transient cerebrospinal fluid leakage (1.3%), infection (0.6%). CONCLUSION MVD is a safe and effective treatment for HFS. A precise recognition of the neurovascular conflict site lead to a successful MVD.

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Microvascular transposition using Teflon sling technique

Neurosurgical Focus: Video ◽

10.3171/2020.6.focvid2040 ◽

2020 ◽

Vol 3 (2) ◽

pp. V2

Author(s):

Mitchell W. Couldwell ◽

Vance Mortimer, AS ◽

William T. Couldwell

Keyword(s):

Trigeminal Neuralgia ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Cranial Nerve ◽

Cranial Nerves ◽

Vascular Compression ◽

Link Type ◽

Pain Syndromes ◽

Established Technique

Microvascular decompression is a well-established technique used to relieve abnormal vascular compression of cranial nerves and associated pain. Here the authors describe three cases in which a sling technique was used in the treatment of cranial nerve pain syndromes: trigeminal neuralgia with predominant V2 distribution, hemifacial spasm, and geniculate neuralgia and right-sided ear pain. In each case, the artery was mobilized from the nerve and tethered with a sling. All three patients had reduction of symptoms within 6 weeks.The video can be found here: https://youtu.be/iM7gukvPz6E

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Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Neurosurgical FOCUS ◽

10.3171/2018.4.focus18122 ◽

2018 ◽

Vol 45 (1) ◽

pp. E2 ◽

Cited By ~ 10

Author(s):

Hiroki Toda ◽

Koichi Iwasaki ◽

Naoya Yoshimoto ◽

Yoshihito Miki ◽

Hirokuni Hashikata ◽

...

Keyword(s):

Trigeminal Neuralgia ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Decompression Surgery ◽

Vascular Compression ◽

Petrosal Vein ◽

Venous Compression ◽

Bridging Veins ◽

Superior Petrosal Vein ◽

Microvascular Decompression Surgery

OBJECTIVEIn microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm, the bridging veins are dissected to provide the surgical corridors, and the veins of the brainstem may be mobilized in cases of venous compression. Strategy and technique in dissecting these veins may affect the surgical outcome. The authors investigated solutions for minimizing venous complications and reviewed the outcome for venous decompression.METHODSThe authors retrospectively reviewed their surgical series of microvascular decompression for trigeminal neuralgia and hemifacial spasm in patients treated between 2005 and 2017. Surgical strategies included preservation of the superior petrosal vein and its tributaries, thorough dissection of the arachnoid sleeve that enveloped these veins, cutting of the inferior petrosal vein over the lower cranial nerves, and mobilization or cutting of the veins of the brainstem that compressed the nerve roots. The authors summarized the patient characteristics, operative findings, and postoperative outcomes according to the vascular compression types as follows: artery alone, artery and vein, and vein alone. They analyzed the data using chi-square and 1-way ANOVA tests.RESULTSThe cohort was composed of 121 patients with trigeminal neuralgia and 205 patients with hemifacial spasm. The superior petrosal vein and its tributaries were preserved with no serious complications in all patients with trigeminal neuralgia. Venous compression alone and arterial and venous compressions were observed in 4% and 22%, respectively, of the patients with trigeminal neuralgia, and in 1% and 2%, respectively, of those with hemifacial spasm (p < 0.0001). In patients with trigeminal neuralgia, 35% of those with artery and venous compressions and 80% of those with venous compression alone had atypical neuralgia (p = 0.015). The surgical cure and recurrence rates of trigeminal neuralgias with venous compression were 60% and 20%, respectively, and with arterial and venous compressions the rates were 92% and 12%, respectively (p < 0.0001, p = 0.04). In patients with hemifacial spasm who had arterial and venous compressions, their recurrence rate was 60%, and that was significantly higher compared to other compression types (p = 0.0008).CONCLUSIONSDissection of the arachnoid sleeve that envelops the superior petrosal vein may help to reduce venous complications in surgery for trigeminal neuralgia. Venous compression may correlate with worse prognosis even with thorough decompression, in both trigeminal neuralgia and hemifacial spasm.

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Microvascular Decompression by the Retrosigmoid Approach for Idiopathic Hemifacial Spasm: Experience with 300 Cases

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949510400804 ◽

1995 ◽

Vol 104 (8) ◽

pp. 610-612 ◽

Cited By ~ 12

Author(s):

Kai-wen Zhang ◽

Zi-ting Shun

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Retrosigmoid Approach ◽

Vascular Compression ◽

Cure Rate ◽

Facial Weakness ◽

Postoperative Meningitis

Three hundred patients with idiopathic hemifacial spasm who underwent microvascular decompression through the retrosigmoid approach are reported. Vascular compression was found in every patient on operation. The results of 1 to 6 years of follow-up show that 276 patients are free of the symptom, 4 patients have markedly diminished spasms and a decreased episode rate, 10 patients have no significant relief from the operation, and 9 have had recurrences of the symptom since the operation. The cure rate in this group is 92%. Complications were sensorineural hearing loss in 13 patients (7 temporary cases, 6 permanent), tinnitus in 7 (4 temporary cases, 3 permanent), temporary postoperative facial weakness in 16, and postoperative meningitis in 10 (9 cases were controlled with antibiotics and 1 patient died).

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