Challenging Microvascular Decompression Surgery for Hemifacial Spasm

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.

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

Journal of Neurosurgery ◽

10.3171/2015.1.jns142714 ◽

2016 ◽

Vol 124 (1) ◽

pp. 90-95 ◽

Cited By ~ 18

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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A single microvascular decompression surgery cures a patient with trigeminal neuralgia, hemifacial spasm, tinnitus, hypertension, and paroxysmal supraventricular tachycardia caused by the compression of a vertebral artery

Neurology India ◽

10.4103/0028-3886.108016 ◽

2013 ◽

Vol 61 (1) ◽

pp. 73 ◽

Cited By ~ 4

Author(s):

Zhang Quanbin ◽

Yin Jia ◽

Wang Wenhua

Keyword(s):

Trigeminal Neuralgia ◽

Vertebral Artery ◽

Supraventricular Tachycardia ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Paroxysmal Supraventricular Tachycardia ◽

Decompression Surgery ◽

Microvascular Decompression Surgery

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1.Anatomy for the Microvascular Decompression Surgery(Morning Seminar-2 Surgical Treatment of Hemifacial Spasm and Trigeminal Neuralgia,The 26^ Annual Meeting of The Japanese Congress of Neurological Surgeons)

Japanese Journal of Neurosurgery ◽

10.7887/jcns.15.331_1 ◽

2006 ◽

Vol 15 (4) ◽

pp. 331

Author(s):

Toshio Matsushima

Keyword(s):

Surgical Treatment ◽

Trigeminal Neuralgia ◽

Annual Meeting ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Decompression Surgery ◽

Microvascular Decompression Surgery

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Microvascular Decompression Surgery for Hemifacial Spasm: The Lateral Suboccipital Infrafloccular Approach

Microsurgical Anatomy and Surgery of the Posterior Cranial Fossa ◽

10.1007/978-4-431-54183-7_12 ◽

2014 ◽

pp. 151-162

Author(s):

Toshio Matsushima

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Decompression Surgery ◽

Microvascular Decompression Surgery

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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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