scholarly journals Retrosigmoid Craniotomy for the Removal of Left Sided Tentorial and Posterior Fossa Meningioma Combined with Microvascular Decompression for Hemifacial Spasm

2018 ◽  
Vol 80 (S 03) ◽  
pp. S294-S295
Author(s):  
Yu-Wen Cheng ◽  
Chun-Yu Cheng ◽  
Zeeshan Qazi ◽  
Laligam N. Sekhar
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Preoperative Imaging ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Root Exit Zone ◽  
Tentorial Meningioma ◽  
Cerebellar Artery ◽  
The Right

This 68-year-old woman presented with repeated episodes of bilateral hemifacial spasm with headache for 5 years and with recent progression of left sided symptoms. Preoperative imaging showed a left sided tentorial meningioma with brain stem and cerebellar compression. Left facial nerve was compressed by the vertebral artery (VA) and the right facial nerve by the anterior inferior cerebellar artery (AICA). This patient underwent left side retrosigmoid craniotomy and mastoidectomy. The cisterna magna was drained to relax the brain. The tumor was very firm, attached to the tentorium and had medial and lateral lobules. The superior cerebellar artery was adherent to the lateral lobule of the tumor and dissected away. The tumor was detached from its tentorial base; we first removed the lateral lobule. Following this, the medial lobule was also completely dissected and removed. The root exit zone of cranial nerve (CN) VII was dissected and exposed. The compression was caused both by a prominent VA and AICA. Initially, the several pieces of Teflon felt were placed for the decompression. Then vertebropexy was performed by using 8–0 nylon suture placed through the VA media to the clival dura. A further piece of Teflon felt was placed between cerebellopontine angle region and AICA. Her hemifacial spasm resolved postoperatively, and she discharged home 1 week later. Postoperative imaging showed complete tumor removal and decompression of left CN VII. This video shows the complex surgery of microsurgical resection of a large tentorial meningioma and microvascular decompression with a vertebropexy procedure.The link to the video can be found at: https://youtu.be/N5aHN9CRJeM.

Neurovascular compression findings in hemifacial spasm

2008 ◽  
Vol 109 (3) ◽  
pp. 416-420 ◽  
Author(s):  
Mauricio Campos-Benitez ◽  
Anthony M. Kaufmann
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Nerve Root ◽  
Posterior Inferior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Exit Point ◽  
Root Exit Zone ◽  
Cerebellar Artery

Object It is generally accepted that hemifacial spasm (HFS) is caused by pulsatile vascular compression upon the facial nerve root exit zone. This 2–3 mm area, considered synonymous with the Obersteiner–Redlich zone, is a transition zone (TZ) between central and peripheral axonal myelination that is situated at the nerve's detachment from the pons. Further proximally, however, the facial nerve is exposed on the pontine surface and emerges from the pontomedullary sulcus. The incidence and significance of neurovascular compression upon these different segments of the facial nerve in patients with HFS has not been previously reported. Methods The nature of neurovascular compression was determined in 115 consecutive patients undergoing their first microvascular decompression (MVD) for HFS. The location of neurovascular compression was categorized to 1 of 4 anatomical portions of the facial nerve: RExP = root exit point; AS = attached segment; RDP = root detachment point that corresponds to the TZ; and CP = distal cisternal portion. The severity of compression was defined as follows: mild = contact without indentation of nerve; moderate = indentation; and severe = deviation of the nerve course. Success in alleviating HFS was documented by telephone interview conducted at least 24 months following MVD surgery. Results Neurovascular compression was found in all patients, and the main culprit was the anterior inferior cerebellar artery (in 43%), posterior inferior cerebellar artery (in 31%), vertebral artery (in 23%), or a large vein (in 3%). Multiple compressing vessels were found in 38% of cases. The primary culprit location was at RExP in 10%, AS in 64%, RDP in 22%, and CP in 3%. The severity of compression was mild in 27%, moderate in 61%, and severe in 12%. Failure to alleviate HFS occurred in 9 cases, and was not related to compression location, severity, or vessel type. Conclusions The authors observed that culprit neurovascular compression was present in all cases of HFS, but situated at the RDP or Obersteiner–Redlich zone in only one-quarter of cases and rarely on the more distal facial nerve root. Since the majority of culprit compression was found more proximally on the pontine surface or even pontomedullary sulcus origin of the facial nerve, these areas must be effectively visualized to achieve consistent success in performing MVD for HFS.

Long-term Outcomes of Microvascular Decompression in the Treatment of Hemifacial Spasm Based on Different Offending Vessels

2019 ◽  
Vol 80 (04) ◽  
pp. 285-290 ◽  
Author(s):  
Hua Zhao ◽  
Yinda Tang ◽  
Xin Zhang ◽  
Jin Zhu ◽  
Yan Yuan ◽  
...  
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Study Groups ◽  
Effective Rate ◽  
Anterior Inferior Cerebellar Artery ◽  
Long Term Outcomes ◽  
Root Exit Zone ◽  
Cerebellar Artery

Objective To evaluate clinical features, outcomes, and complications in patients with hemifacial spasm (HFS) after microvascular decompression (MVD) of different offending vessels. Methods Clinical data were collected from 362 patients with HFS treated with MVD between January 2013 and January 2014. Patients were divided into five groups based on the offending vessel: A (anterior inferior cerebellar artery [AICA] compression), B (posterior inferior cerebellar artery [PICA] compression), C (AICA plus PICA compression), D (vertebral artery [VA] compression), and E (VA plus small vessel compression). Results The most common offending vessel was the AICA (51.38%). The most common compression site was the root exit zone. During the follow-up period, the effective rate was 95.48% in group A, 92.15% in group B, 93.10% in group C, 90.14% in group D, and 91.45% in group E. Twenty-nine patients exhibited delayed facial palsy, the most common complication. Conclusion No statistically significant differences were found in long-term outcomes or MVD-related complications among the study groups. The type of offending vessel was not a prognostic factor for MVD in patients with HFS.

Hemifacial spasm

1982 ◽  
Vol 57 (6) ◽  
pp. 753-756 ◽  
Author(s):  
Tsutomu Iwakuma ◽  
Akihisa Matsumoto ◽  
Nishio Nakamura
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Posterior Inferior Cerebellar Artery ◽  
Content Type ◽  
Stylomastoid Foramen ◽  
Root Exit Zone ◽  
Selective Neurectomy ◽  
Fine Print

✓ Patients with hemifacial spasm were treated by three different surgical procedures: 1) partial sectioning of the facial nerve just distal to the stylomastoid foramen; 2) selective neurectomy of facial nerve branches; and 3) microvascular decompression. A retromastoid craniectomy with microvascular decompression was most effective in relieving hemifacial spasm and synkinesis. In a postmorten examination on one patient, microscopic examination of the facial nerve, which was compressed by an arterial loop of the posterior inferior cerebellar artery at the cerebellopontine angle, revealed fascicular demyelination in the nerve root. On the basis of surgical treatment, electromyography, and neuropathological findings, the authors conclude that compression of the facial nerve root exit zone by vascular structures is the main cause of hemifacial spasm and synkinesis.

Microvascular decompression for hemifacial spasm

1991 ◽  
Vol 75 (3) ◽  
pp. 388-392 ◽  
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.

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 Microvascular Decompression by Interposition Method for Treatment of Trigeminal Neuralgia Due to Vertebrobasilar Dolichoectasia: A Retrospective Single-Center Study

2021 ◽  
Author(s):  
Feng Yu ◽  
Jia Yin ◽  
Pei-gang Lu ◽  
Zhen-yu Zhao ◽  
Yong-qiang Zhang ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Long Term Results ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Symptom Duration ◽  
Free Survival ◽  
Kaplan Meier ◽  
Vertebrobasilar Dolichoectasia ◽  
Cerebellar Artery

Abstract Trigeminal neuralgia (TN) due to vertebrobasilar dolichoectasia (VBD) is a rare disease that can be challenging to treat. The objectives of this study are to investigate the characteristics of patients with TN due to VBD and to analyze the efficacy of microvascular decompression (MVD) by the interposition method for treatment of the condition. From 2010 till 2020, the data of 30 patients with TN due to VBD who were treated with MVD by the interposition method were analyzed retrospectively. The characteristics of the patients were compared with those of patients with non-VBD TN (n = 815). Kaplan–Meier survival analysis was performed to determine pain-free survival. The 30 patients (21 males, 9 females; mean age, 63.03 years) accounted for 3.55% of all patients with TN during the study period. In 30 patients, the offending vessel was the basilar artery (BA) in 1 patient, the vertebral artery (VA) in 6 patients, the VA plus the superior cerebellar artery (SCA) in 6 patients, the VA plus the anterior inferior cerebellar artery (AICA) in 12 patients, and the VA+SCA+AICA in 5 patients. Compared to non-VBD TN patients, those with TN due to VBD were significantly more likely to be male, to have TN of the left side, and to have hypertension (all P < 0.001). Mean age at surgery (P = 0.057) and symptom duration (P = 0.308) were comparable between the two groups. All 30 patients had immediate relief of facial pain after MVD and could stop medication. There were no postoperative complications. Over mean follow-up of 76.67 months, 3 patients had recurrence. The mean duration of pain-free survival was 70.77 months. In conclusions, TN due to VBD appears to be more likely in males, in those with hypertension, and to involve the left side. The interposition method performed by experienced and skilled neurosurgeons is a safe and effective treatment for TN due to VBD. Further studies are needed to analyze the associated long-term results and the pain recurrence rate among this special population.

Outcome of Endoscope-Assisted Microvascular Decompression in Patients With Hemifacial Spasm Caused by Severe Indentation of the Brain Stem at the Pontomedullary Sulcus by the Posterior Inferior Cerebellar Artery

2021 ◽  
Author(s):  
Ehab El Refaee ◽  
Steffen Fleck ◽  
Marc Matthes ◽  
Sascha Marx ◽  
Joerg Baldauf ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Transitional Zone ◽  
Effective Treatment Option ◽  
Cerebellar Artery ◽  
The Brain

Abstract BACKGROUND Microvascular decompression (MVD) is the most effective treatment option for hemifacial spasm (HFS). However, deeply located forms of compression would require proper identification to allow for adequate decompression. OBJECTIVE To describe the usefulness of endoscopic visualization in one of the most challenging compression patterns in HFS, where the posterior inferior cerebellar artery (PICA) loop is severely indenting the brain stem at the proximal root exit zone of facial nerve along the pontomedullary sulcus. METHODS Radiological and operative data were checked for all patients in whom severe indentation of the brainstem by PICA at pontomedullary sulcus was recorded and endoscope-assisted MVD was performed. Clinical correlation and outcome were analyzed. RESULTS A total of 58 patients with HFS were identified with radiological and surgical evidence proving brainstem indentation at the VII transitional zone. In 31 patients, PICA was the offending vessel to the facial nerve. In 3 patients, the PICA loop was mobilized under visualization of a 45° endoscope. A total of 31 patients had a mean follow-up duration of 52.1 mo. The mean duration between start of complaints and surgery was 7.2 yr. In the last follow-up, all patients had remarkable spasm improvement. A total of 5 patients had more than 90% disappearance of spasms and 26 patients experienced spasm-free outcome. CONCLUSION Although severe indentation of brain stem implies morphological damage, outcome after MVD is excellent. A 45° endoscope is extremely helpful to identify compression down at the pontomedullary sulcus. Deeply located compression site can easily be missed with microscopic inspection alone.

“Double-Stick Tape” Technique for Transposition of an Offending Vessel in Microvascular Decompression: Technical Case Report

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. onsE377-onsE382 ◽  
Author(s):  
Tomotsugu Ichikawa ◽  
Takashi Agari ◽  
Kazuhiko Kurozumi ◽  
Tomoko Maruo ◽  
Toru Satoh ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Ventral Surface ◽  
Tissue Adhesive ◽  
Anterior Inferior Cerebellar Artery ◽  
Fibrin Tissue Adhesive ◽  
History Of ◽  
Feasible Alternative ◽  
The Right ◽  
Pontomedullary Junction

Abstract Background And Importance: Severe hemifacial spasm caused by compression by a tortuous vertebral artery (VA) often is encountered and is difficult to treat. We describe a patient with hemifacial spasm caused by compression of the facial nerve by a tortuous VA. A simple and effective transposition approach, a “double-stick tape” technique, to the offending artery using a fibrin tissue-adhesive collagen fleece product (TachoComb) is reported. Clinical Presentation: A 65-year-old woman presented with an 8-year history of right-sided facial spasms, including the orbicularis oculi and orbicularis oris muscles. MRI revealed a tortuous right VA indented into the pontomedullary junction. The right anterior inferior cerebellar artery (AICA) also contacted the proximal portion of the facial nerve. Surgical exploration with standard retrosigmoid craniotomy was performed. The offending VA was dissected away from the pontomedullary junction toward the cranial base. A small piece of TachoComb, with fibrin glue applied on the non-coated side of the fleece to make a “double-stick tape,” was then placed on the ventral surface of the VA. Until the glue hardened, the VA was held away from the brainstem onto the dura of the petrous pyramid. After this procedure, AICA transposition was performed. The patient’s symptoms were completely resolved immediately after surgery, and she remained asymptomatic at her 1 year follow-up visit. Conclusion: The advantage of our “double-stick tape” technique is the simplicity of the procedure. The present technique is a feasible alternative for the treatment of hemifacial spasm caused by a tortuous VA.

Vertebral artery pexy for microvascular decompression of the facial nerve in the treatment of hemifacial spasm

2011 ◽  
Vol 114 (6) ◽  
pp. 1800-1804 ◽  
Author(s):  
Manuel Ferreira ◽  
Brian P. Walcott ◽  
Brian V. Nahed ◽  
Laligam N. Sekhar
Keyword(s):  
Facial Nerve ◽  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Anterior Inferior Cerebellar Artery ◽  
Careful Study ◽  
Venous Compression ◽  
Select Group ◽  
Far Lateral Approach

Object Hemifacial spasm (HFS) is caused by arterial or venous compression of cranial nerve VII at its root exit zone. Traditionally, microvascular decompression of the facial nerve has been an effective treatment for posterior inferior and anterior inferior cerebellar artery as well as venous compression. The traditional technique involves Teflon felt or another construct to cushion the offending vessel from the facial nerve, or cautery and division of the offending vein. However, using this technique for severe vertebral artery (VA) compression can be ineffective and fraught with complications. The authors report the use of a new technique of VA pexy to the petrous or clival dura mater in patients with HFS attributed to a severely ectatic and tortuous VA, and detail the results in a series of patients. Methods Six patients with HFS due to VA compression underwent a retrosigmoid craniotomy, combined with a far-lateral approach in some patients. On identification of the site of VA compression, the vessel was mobilized adequately for the decompression. Great care was taken to avoid kinking the perforating vessels arising from the VA. Two 8-0 nylon sutures were passed through to the wall of the VA and then through the clival or petrous dura, and then tied to alleviate compression on cranial nerve VII. Results Patients were followed for at least 1 year postoperatively (mean 2.7 years, range 1–4 years). All 6 patients had complete resolution of their HFS. Facial function was tested postoperatively, and was stable when compared with the preoperative baseline. Two of the 3 patients with preoperative tinnitus had resolution of this symptom after the procedure. Postoperative imaging demonstrated VA decompression of the facial nerve and no evidence of stroke in all patients. One patient suffered from hearing loss, another developed a postoperative transient unilateral vocal cord paralysis, and a third patient developed a pseudomeningocele that resolved with the placement of a lumbar drain. Conclusions Hemifacial spasm and other neurovascular syndromes are effectively treated by repositioning the compressing artery. Careful study of the preoperative MR images may identify a select group of patients with HFS due to an ectatic VA. Rather than traditional decompression with only pledget placement, these patients may benefit from a VA pexy to provide an effective, safe, and durable resolution of their symptoms while minimizing surgical complications.

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