Transposition of the Culprit Artery Passing Between the Facial Nerve and Auditory Nerve in Microvascular Decompression Surgery for Hemifacial Spasm

2019 ◽  
Vol 127 ◽  
pp. e996-e1002 ◽  
Author(s):  
Kenichi Amagasaki ◽  
Saiko Watanabe ◽  
Kazuaki Naemura ◽  
Naoyuki Shono ◽  
Atushi Hosono ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Auditory Nerve ◽  
Decompression Surgery ◽  
Microvascular Decompression Surgery

Interventional Neuroradiology in Hemifacial Spasm

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 32-36 ◽  
Author(s):  
K. Yamashita ◽  
S. Okamoto ◽  
K. Hosotani ◽  
S. Nakatsu ◽  
M. Hojo ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Contrast Material ◽  
Interventional Neuroradiology ◽  
Decompression Surgery ◽  
Neurovascular Compression ◽  
Root Exit Zone ◽  
Functional Investigation ◽  
Microvascular Decompression Surgery

There have never been functional studies in the diagnosis of hemifacial spasm caused by neurovascular compression. We used neurointerventional techniques to conduct a functional investigation of the artery responsible for hemifacial spasm in seven patients. A microcatheter was inserted into the various arteries of the posterior circulation under systemic heparinization, and its effect on the spasm was evaluated clinically and electromyographically. In six patients who underwent microvascular decompression surgery, the vessels compressing the root exit zone of the facial nerve were surgically determined, and compared with the result of the procedure. The catheter was inserted into twelve arteries. The spasms were stopped immediately and completely by the insertion of the catheter into seven arteries. Six of them were surgically proven to compress the root exit zone of the facial nerve. The spasm was changed in frequency or in type by the insertion into two arteries. These arteries were also compressing the root exit zone. One artery was located at a more peripheral part of it and the other was running over another artery compressing the root exit zone. The spasms were not affected at all by the insertion into three arteries. These arteries were not observed in the operative field and had no contact with the nerve. Superselective ‘angiograms showedpositional qnd configurational changes of the arteries. There was no arterial spasm and tight catheterization leading to stasis of contrast material within the arteries. There were no complications related to the procedures. Functional relationship between the artery and the spasms was established in all the patients, and one patient refused surgery because the frequency of the spasm was reduced by the procedure. The result of this study may suggest that a functional investigation of hemifacial spasm is feasible and seems useful for selecting good candidates for microvascular decompression surgery.

scholarly journals Penetrating Offending Vessel, The Most Surgically Demanding Type during Microvascular Decompression Surgery in Hemifacial Spasm

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Seunghoon Lee ◽  
Kwan Park
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Decompression Surgery ◽  
Neurovascular Compression ◽  
Extent Of Surgery ◽  
Free Running ◽  
The One ◽  
Microvascular Decompression Surgery

Abstract INTRODUCTION Microvascular decompression (MVD) is the most effective and curative treatment option for neurovascular compression syndrome and it is increasingly performed around the world. This study aimed to identify and describe the most technically difficult cases, which were the patients with penetrating offending vessel through the facial nerve, from our experiences and to give surgical tips for the successful MVD. METHODS Surgical records and intraoperative video of hemifacial spasm patients with penetrating offending vessels were reviewed. Interposition of Teflon felt between nerve and vessel was pursued, and neurectomy was avoided as much as possible. RESULTS Five patients with hemifacial spasm were identified as having a penetrating offending vessel through the facial nerve during the last 5 yr of MVD surgery in our institution. Four AICAs and one PICA were the causative vessels. Partial neurectomy was required in 1 patient. During the median follow-up of 6 mo (range, 1-26), all patients were spasm-free. No patients including the one with partial neurectomy were involved in facial palsy or hearing loss. CONCLUSION MVD in HFS patients with penetrating offending vessel through the facial nerve is the most surgically challenging and demands a high surgical skill. Interposition with Teflon felt is effective and neurectomy should be avoided. Intraoperative monitoring of free-running EMG and abnormal muscle response are helpful to decide the extent of surgery.

Microvascular Decompression Surgery for Hemifacial Spasm

2016 ◽  
Vol 27 (1) ◽  
pp. 124-127 ◽  
Author(s):  
Hongwu Qi ◽  
Weining Zhang ◽  
Xudong Zhang ◽  
Caixia Zhao
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Decompression Surgery ◽  
Microvascular Decompression Surgery

Importance of awareness of the rhomboid lip in microvascular decompression surgery for hemifacial spasm

2013 ◽  
Vol 119 (4) ◽  
pp. 1038-1042 ◽  
Author(s):  
Yukiko Nakahara ◽  
Toshio Matsushima ◽  
Tetsuya Hiraishi ◽  
Tetsuro Takao ◽  
Takeshi Funaki ◽  
...  
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Fourth Ventricle ◽  
Ventral Side ◽  
Preoperative Imaging ◽  
Decompression Surgery ◽  
Mr Images ◽  
Root Exit Zone ◽  
Inferior Portion ◽  
Microvascular Decompression Surgery

Object The authors adopted the infrafloccular approach for microvascular decompression (MVD) surgery to treat hemifacial spasm (HFS). The inferior portion of the flocculus is retracted to observe the root exit zone of cranial nerve (CN) VII between CN IX and the flocculus. During the procedure, the rhomboid lip, a sheetlike layer of neural tissue forming the lateral recess of the fourth ventricle, is sometimes encountered. The existence of the rhomboid lip in cases of HFS was reviewed to determine the importance of the structure during MVD surgery. Methods Preoperative imaging and intraoperative observations in 34 consecutive cases of HFS treated in the period from October 2008 through September 2011 were used to assess the frequency of encountering the rhomboid lip. Results The rhomboid lip was observed during MVD surgery in 9 (26.5%) of the 34 cases but had been demonstrated on preoperative MR images in only 3 cases (8.8%). On T2-weighted images, it appeared as a high-intensity nonstructural area on the ventral side of the flocculus and continued into the fourth ventricle via the foramen of Luschka. Conclusions A large rhomboid lip presents an impediment to MVD surgery in a significant minority of patients with HFS. It is seldom observed on preoperative MR images. Proper dissection of the rhomboid lip away from the arachnoid membrane and/or the lower CNs during MVD surgery provides good visualization of the root exit zone of CN VII and reduces injury of CNs IX and X, avoiding postoperative deficits like dysphagia.

scholarly journals Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations

2016 ◽  
Vol 124 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Mark Gregory Bigder ◽  
Anthony M. Kaufmann
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Senior Author ◽  
Decompression Surgery ◽  
Neurovascular Compression ◽  
Exit Point ◽  
Root Exit Zone ◽  
Prior Surgery ◽  
Microvascular Decompression Surgery

OBJECT Microvascular decompression (MVD) surgery for hemifacial spasm (HFS) is potentially curative. The findings at repeat MVD in patients with persistent or recurrent HFS were analyzed with the aim to identify factors that may improve surgical outcomes. METHODS Intraoperative findings were determined from review of dictated operative reports and operative diagrams for patients who underwent repeat MVD after prior surgery elsewhere. Clinical follow-up was obtained from the hospital and clinic records, as well as telephone questionnaires. RESULTS Among 845 patients who underwent MVD performed by the senior author, 12 had been referred after prior MVD for HFS performed elsewhere. Following repeat MVD, all patients improved and complete spasm resolution was described by 11 of 12 patients after a mean follow-up of 91 ± 55 months (range 28–193). Complications were limited to 1 patient with aggravation of preexisting hearing loss and mild facial weakness and 1 patient with aseptic meningitis without sequelae. Significant factors that may have contributed to the failure of the first surgery included retromastoid craniectomies that did not extend laterally to the sigmoid sinus or inferiorly to the posterior fossa floor in 11 of 12 patients and a prior surgical approach that focused on the cisternal portion of the facial nerve in 9 of 12 patients. In all cases, significant persistent neurovascular compression (NVC) was evident and alleviated more proximally on the facial root exit zone (fREZ). CONCLUSIONS Most HFS patients will achieve spasm relief with thorough alleviation of NVC of the fREZ, which extends from the pontomedullary sulcus root exit point to the Obersteiner-Redlich transition zone.

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