Endoscopic Microvascular Decompression with Transposition for Trigeminal Neuralgia and Hemifacial Spasm: Technical Note

Abstract OBJECTIVE We have used three different approaches, namely, the infratentorial lateral supracerebellar approach, the lateral suboccipital infrafloccular approach, and the transcondylar fossa approach, for microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia, respectively. Each approach is a variation of the lateral suboccipital approach to the cerebellopontine angle (CPA); however, each has a different site of bony opening, a different surgical direction, and a different route along the cerebellar surface. METHODS The infratentorial lateral supracerebellar approach is used to access the trigeminal nerve in the superior portion of the CPA through the lateral aspect of the cerebellar tentorial surface. The lateral suboccipital infrafloccular approach is directed through the inferior part of the cerebellar petrosal surface to reach the root exit zone of the facial nerve below the flocculus. The transcondylar fossa approach is used to access the glossopharyngeal nerve in the inferior portion of the CPA through the cerebellar suboccipital surface, after extradural removal of the jugular tubercle as necessary. RESULTS In all three approaches, the cerebellar petrosal surface is never retracted transversely, that is, the cerebellar retraction is never directed parallel to the longitudinal axis of the VIIIth cranial nerve, dramatically reducing the risk of postoperative hearing loss. CONCLUSION The greatest advantage of the differential selection of the surgical approach is increased ability to reach the destination in the CPA accurately, with minimal risk of postoperative cranial nerve palsy.

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A New Application of Gelatin Sponge in the Treatment of Hemifacial Spasm by Microvascular Decompression: A Technical Note

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1720994 ◽

2021 ◽

Author(s):

Bowen Chang ◽

Yinda Tang ◽

Xiangyu Wei ◽

Shiting Li

Keyword(s):

Hearing Loss ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Facial Palsy ◽

Poor Response ◽

Technical Note ◽

Gelatin Sponge ◽

Group Differences ◽

Success Rates

Abstract Objectives Microvascular decompression (MVD) for facial nerve remains the highly efficient hemifacial spasm (HFS) treatment. Nonetheless, a variety of cases have poor response to MVD. Using Teflon plus gelatin sponge in MVD seems to be a good solution. No existing study has examined the efficacy of using Teflon combined with gelatin sponge during MVD for HFS. Therefore, this study aimed to compare the efficacy of Teflon combined with gelatin sponge in HFS patients relative to that of Teflon alone. Patients and Methods We retrospectively compared the follow-up results of patients treated with Teflon and gelatin sponge with those treated with Teflon alone previously. Six hundred and eighty-eight primary HFS patients undergoing surgery from January 2010 to January 2018 were retrospectively analyzed. Three hundred and forty-seven cases received simple Teflon, while 342 cases underwent Teflon combined with gelatin sponge. Results In the Teflon plus gelatin sponge group, the incidences of facial palsy and hearing loss at 1 day, 1 year, and 2 years following surgery was significantly lower than those in the simple Teflon group. Differences in the success rates between Teflon plus gelatin sponge and the simple Teflon group were not statistically significant at 1 day, 1 year, and 2 years after surgery. The recurrence rate in the Teflon plus gelatin sponge group was significantly lower at 2 years. Conclusion For HFS patients undergoing MVD, using Teflon plus gelatin sponge can remarkably reduce the incidence of recurrence, facial palsy, and hearing loss compared with those using Teflon alone.

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Endoscopic-Assisted Microvascular Decompression

Effective Techniques for Managing Trigeminal Neuralgia - Advances in Medical Diagnosis, Treatment, and Care ◽

10.4018/978-1-5225-5349-6.ch007 ◽

2018 ◽

pp. 139-154

Author(s):

M. Yashar S. Kalani ◽

Michael R. Levitt ◽

Celene B. Mulholland ◽

Charles Teo ◽

Peter Nakaji

Keyword(s):

Trigeminal Neuralgia ◽

Minimally Invasive ◽

Effective Treatment ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Patient Population ◽

Surgical Intervention ◽

Cranial Nerves ◽

Vascular Compression ◽

Ephaptic Transmission

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 of cranial nerves: lessons learned after 4400 operations

Journal of Neurosurgery ◽

10.3171/jns.1999.90.1.0001 ◽

1999 ◽

Vol 90 (1) ◽

pp. 1-8 ◽

Cited By ~ 448

Author(s):

Mark R. McLaughlin ◽

Peter J. Jannetta ◽

Brent L. Clyde ◽

Brian R. Subach ◽

Christopher H. Comey ◽

...

Keyword(s):

Hearing Loss ◽

Trigeminal Neuralgia ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Cranial Nerve ◽

Glossopharyngeal Neuralgia ◽

Complication Rates ◽

Content Type ◽

Csf Leakage ◽

Fine Print

Object. Microvascular decompression has become an accepted surgical technique for the treatment of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and other cranial nerve rhizopathies. The senior author (P.J.J.) began performing this procedure in 1969 and has performed more than 4400 operations. The purpose of this article is to review some of the nuances of the technical aspects of this procedure.Methods. A review of 4415 operations shows that numerous modifications to the technique of microvascular decompression have occurred during the last 29 years. Of the 2420 operations performed for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia before 1990, cerebellar injury occurred in 21 cases (0.87%), hearing loss in 48 (1.98%), and cerebrospinal fluid (CSF) leakage in 59 cases (2.44%). Of the 1995 operations performed since 1990, cerebellar injuries declined to nine cases (0.45%), hearing loss to 16 (0.8%), and CSF leakage to 37 (1.85% p < 0.01, test for equality of distributions). The authors describe slight variations made to maximize surgical exposure and minimize potential complications in each of the six principal steps of this operation. These modifications have led to decreasing complication rates in recent years.Conclusions. Using the techniques described in this report, microvascular decompression is an extremely safe and effective treatment for many cranial nerve rhizopathies.

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Follow-up Results of Microvascular Decompression in Trigeminal Neuralgia and Hemifacial Spasm

Neurosurgery ◽

10.1097/00006123-199701000-00009 ◽

1997 ◽

Vol 40 (1) ◽

pp. 46-52 ◽

Cited By ~ 31

Author(s):

Akinori Kondo

Keyword(s):

Trigeminal Neuralgia ◽

Hemifacial Spasm ◽

Microvascular Decompression

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Serious Complications of Microvascular Decompression Operations for Trigeminal Neuralgia and Hemifacial Spasm

Neurosurgery ◽

10.1227/00006123-198802000-00012 ◽

1988 ◽

Vol 22 (2) ◽

pp. 248-352 ◽

Cited By ~ 58

Author(s):

Junya Hanakita ◽

Akinori Kondo

Keyword(s):

Status Epilepticus ◽

Subarachnoid Hemorrhage ◽

Trigeminal Neuralgia ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Posterior Cerebral Artery ◽

Acute Subdural Hematoma ◽

Traumatic Aneurysm ◽

Acute Hydrocephalus ◽

The Brain

Abstract Serious complications of microvascular decompression operations for trigeminal neuralgia or hemifacial spasm are reported. Among 278 patients who underwent microvascular decompression, 9 serious complications were observed: 1 intracerebellar hematoma with acute hydrocephalus, 1 cerebellar swelling with acute hydrocephalus, 1 supratentorial acute subdural hematoma, 2 status epilepticus, 1 infarction of the brain stem, 1 subarachnoid hemorrhage due to traumatic aneurysm, and 1 infarction in the territory of the posterior cerebral artery. Of the 9 patients with such complications, 2 died. The possible causes of such serious complications are discussed. (Neurosurgery 22:348-352, 1988)

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Preoperative evaluation of neurovascular relationships for microvascular decompression in the cerebellopontine angle in a virtual reality environment

Journal of Neurosurgery ◽

10.3171/2009.9.jns091012 ◽

2010 ◽

Vol 113 (3) ◽

pp. 479-485 ◽

Cited By ~ 11

Author(s):

Zhuo-Ying Du ◽

Xiang Gao ◽

Xiao-Luo Zhang ◽

Zhi-Qiu Wang ◽

Wei-Jun Tang

Keyword(s):

Virtual Reality ◽

Trigeminal Neuralgia ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Cerebellopontine Angle ◽

Surgical Simulation ◽

Preoperative Evaluation ◽

Spatial Understanding ◽

Idiopathic Trigeminal Neuralgia ◽

And Training

Object In this paper the authors' goal was to evaluate the feasibility and efficacy of a virtual reality (VR) system in preoperative planning for microvascular decompression (MVD) procedures treating idiopathic trigeminal neuralgia and hemifacial spasm. The system's role in surgical simulation and training was also assessed. Methods Between May 2008 and April 2009, the authors used the Dextroscope system to visualize the neurovascular complex and simulate MVD in the cerebellopontine angle in a VR environment in 16 patients (6 patients had trigeminal neuralgia and 10 had hemifacial spasm). Reconstructions were carried out 2–3 days before MVD. Images were printed in a red-blue stereoscopic format for teaching and discussion and were brought into the operating room to be compared with real-time intraoperative findings. Results The VR environment was a powerful aid for spatial understanding of the neurovascular relationship in MVD for operating surgeons and trainees. Through an initial series of comparison/confirmation experiences, the senior neurosurgeon became accustomed to the system. He could predict intraoperative problems and simulate surgical maneuvering, which increased his confidence in performing the procedure. Conclusions The Dextroscope system is an easy and rapid method to create a stereoscopic neurovascular model for MVD that is highly concordant with intraoperative findings. It effectively shortens the learning curve and adds to the surgeon's confidence.

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