Clinical Research on Delayed Cure after Microvascular Decompression for Hemifacial Spasm

2019 ◽  
Vol 81 (03) ◽  
pp. 195-199
Author(s):  
Ming-Wu Li ◽  
Xiao-Feng Jiang ◽  
Min Wu ◽  
Fang He ◽  
Chaoshi Niu
Keyword(s):  
Clinical Data ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Chi Square ◽  
Related Factors ◽  
Accurate Identification ◽  
Root Exit Zone ◽  
Chi Square Test ◽  
Disease Grade ◽  
Muscle Responses

Abstract Objective The clinical data of patients with hemifacial spasm (HFS) were analyzed statistically to identify factors leading to delayed cure after microvascular decompression (MVD). Methods A retrospective analysis of the clinical data of 600 patients with HFS subjected to MVD from March 2016 to May 2018 was performed. Student t test, chi-square test, logistic regression analysis, and multivariate analysis of variance were used to analyze the correlation between delayed cure and its related factors. Results Among the 600 patients enrolled, 117 had delayed cure after MVD. The shortest duration of delayed cure was 4 days, and the longest was 540 days, with an average of 108 days. The frequency of delayed improvement in these patients was not associated with sex, age, or offending vessel type (p > 0.05); however, delayed cure was positively correlated with the course of the disease, grade of HFS severity, and disappearance of abnormal muscle responses during the operation (p < 0.05). Moreover, a longer disease course was associated with more severe related symptoms and a longer duration of postoperative delayed cure. Conclusion MVD is an effective treatment for HFS. Given that postoperative delayed cure was unavoidable, even with accurate identification of the offending vessel and sufficient decompression of the root exit zone, delayed cure should be considered in patients undergoing reoperation due to lack of remission or relapse after the operation. Additionally, the timing of efficacy assessments should be delayed.

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.

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.

Cultural Constraints To Female Higher Education In Malakand Division, Pakistan

2018 ◽  
Vol 17 (1) ◽  
pp. 203-218
Author(s):  
Sameer Ul Khaliq Jan ◽  
Ahmad Ali ◽  
Muhammad Niqab
Keyword(s):  
Higher Education ◽  
Freedom Of Expression ◽  
Snowball Sampling ◽  
Educational Facilities ◽  
Early Puberty ◽  
Chi Square ◽  
Related Factors ◽  
Chi Square Test ◽  
The Government ◽  
Cultural Constraints

The current study was aimed to analyze the Pakhtun cultural constraints in the way of female higher education. For this purpose, the data was collected through a survey instrument by snowball sampling and selected 384 respondents from Malakand division, Khyber Pakhtunkhwa, Pakistan. The collected data were analyzed through SPSS. A Chi-Square test was applied in order to find out the association between independent (Pakhtun culture) and a dependent variable (low female higher education). The results show that there is a high and significant relationship between the low ratio of female higher education and sub-dimensions of Pakhtun culture i.e. early puberty, conservatism, Pardah, home related factors, Son preference, male dominancy, lack of freedom of expression for female, early/child marriage, noninvolvement of female in decision making, spending money of parents but benefits goes to husband family, non-acceptance of co-education, living in hostel of female and cultural interpretation of religion are various risk factors for low female higher education in Pakhtun society. The study recommends that the government should focus on women education, create awareness regarding female education and provide better educational facilities and incentives for women. Besides, more employment opportunities should be created to enhance female higher education.

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 The Frequency and Related Factors of Internet Addiction in Externship and Internship Students of Kerman University of Medical Sciences, 2018

2021 ◽  
Author(s):  
Mina Danaei ◽  
Ali Akbar Rohani ◽  
Ali Sajadi ◽  
Mohsen Momeni
Keyword(s):  
Medical Students ◽  
Internet Addiction ◽  
Cross Sectional Study ◽  
The Internet ◽  
Medical Sciences ◽  
Chi Square ◽  
Related Factors ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Chi Square Test

Introduction: Internet addiction is a global phenomenon with an increasing trend in university students. The aim of this study was to investigate the frequency and factors affecting internet addiction in externship and internship medical students of Kerman University of Medical Sciences in 2018. Methods: This cross-sectional study was carried out on externship and internship medical students of Kerman University of Medical Sciences in 2018 during a 6-month period using convenience sampling method. In this study, the valid and reliable self-administered questionnaire of “Kimberly-Young internet addiction questionnaire” was used to collect the research data. The attainable scores in this questionnaire range from 20 to 100, so that  higher scores show greater dependence on the Internet. Data were analyzed by SPSS version 20 using the Chi-square test. A significant level was set at lower than 0.05. Results: Among the participants, 46 participants (18.4%) were normal users, 127 (50.8%) were at risk, and 77 (30.8%) were addicted to the Internet. Among the demographic factors, a significant relationship was found between gender (p = 0.041) and educational level (p = 0.024) with Internet addiction. Conclusion: policymakers should pay particular attention to the issue of Internet addiction in medical students, since Internet addiction may cause these students to neglect their critical duties during externship and internship. In this regard, holding effective training courses can be helpful.

scholarly journals How Organizational and Trainee Characteristics Influence the Training Program of Employees in Djibouti Port

2019 ◽  
Vol 8 (9S2) ◽  
pp. 269-277
Keyword(s):  
Training Program ◽  
Sampling Method ◽  
Positive Impact ◽  
Training And Development ◽  
Development Programs ◽  
Chi Square ◽  
Related Factors ◽  
Dependent Variables ◽  
Chi Square Test ◽  
Level Of Training

The present paper aims to examine how the organizational and trainee characteristics influence the effectiveness of a training program in Djibouti Port. To prove this, quantitative analysis was carried out with the help of a questionnaire. The survey was given to port employees and gets their opinion about the effectiveness of the training program in their port. The survey was framed from the perspective of independent and dependent variables chosen from the literature. Further for collecting the sample the random sampling method was adopted. All aspects of training and organizational characteristic variables were utilized. Data analysis involved like correlation and regression, chi-square test with the help of SPSS 21 version. Confidentiality was maintained throughout the research. Study findings observed that there is a positive impact of organization and trainee related factors that impact the training effectiveness. Further, it is noticed that the current level of training and development programs in Djibouti Port Trust was effective. Overall from the study found it is concluded that the training and development need in the ports and explore whether the needs differ between the ports.

scholarly journals HIV/AIDS-RELATED FACTORS AMONGST THE LGBTQ PEOPLE IN SURABAYA

2020 ◽  
Vol 30 (2) ◽  
pp. 69
Author(s):  
Ridhwan Biosia Wiratama ◽  
Samsriyaningsih Handayani ◽  
Soetjipto Soetjipto
Keyword(s):  
Hiv Infections ◽  
Hiv Status ◽  
Enabling Factors ◽  
Chi Square ◽  
Related Factors ◽  
Cross Sectional ◽  
Social Patterns ◽  
Chi Square Test ◽  
Immunodeficiency Syndrome ◽  
Hiv Aids

Background: Acquired Immunodeficiency Syndrome (AIDS) is one of the diseases that cause death in the world caused by the Human Immunodeficiency Virus (HIV). Since it was first discovered in 1987 until December 2017, the number of person with AIDS was 102,667, and the number of person with HIV infections was 280,623. HIV/AIDS cases in East Java occupy the second highest position in Indonesia. Surabaya is the first city in East Java with 934 HIV cases in 2017. LGBTQ is one of the groups at risk of getting HIV/AIDS with prevalence was 24.82%. Objective: The purpose of this study was to analyze the factors that influence LGBTQ related to the incidence of HIV/AIDS in Surabaya. Material and Method:  This study was an analytic research using a cross sectional approach. The subject was 80 LGBTQ respondents. Data was collected using questionnaires then analyzed using Chi-square test, with α = 0.05. Result:  The highest age group was 42-46 years (22.5%), the last level of education was dominated by high school (41.3%), and the most types of work were private employees (47.4%). There was no correlation between predisposing factors in the form of knowledge about HIV/AIDS and respondent's HIV status (p = 0.729), there was no correlation between enabling factors in the form of condoms and respondent's HIV status (p = 0.624), there was no correlation between the reinforcing factor in the form of family support with the HIV status of the respondent (p = 0.674) and there was no correlation between preventive behavior and the HIV status of the respondent (p = 0.540).  Conclusion: The need for support between LGBTQs for the dangers of HIV/AIDS and LGBTQ should be more aware of their own health and environment with their social patterns

scholarly journals Research Article. Characteristics of Sleep Apnea Assessed Before Discharge in Patients Hospitalized with Acute Heart Failure

2017 ◽  
Vol 63 (1) ◽  
pp. 19-22
Author(s):  
Ildikó Kocsis ◽  
Lajos Fehérvári ◽  
Zoltán Fogarasi ◽  
István Adorján Szabó ◽  
Attila Frigy
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sleep Apnea ◽  
Acute Heart Failure ◽  
Stable Condition ◽  
Descriptive Statistics ◽  
Chi Square ◽  
Related Factors ◽  
Research Article ◽  
Chi Square Test

AbstractObjectives. Evaluation of the characteristics of sleep apnea (SA) in patients hospitalized with acute heart failure, considering that undiagnosed SA could contribute to early rehospitalization. Methods. 56 consecutive patients (13 women, 43 men, mean age 63.12 years) with acute heart failure, in stable condition, underwent nocturnal polygraphy before hospital discharge. The type and severity of SA was determined. Besides descriptive statistics, correlations between the severity of SA and clinical and paraclinical characteristics were also analyzed (t-test, chi-square test, significancy at alpha < 0.05). Results. 12 (21.4%) subjects were free of SA (AHI - apnea-hipopnea index <5/h), 15 (26.7%) had mild SA (AHI=5-14/h), 17 (30.3%) had moderate SA (AHI 15-30/h), and 12 (21.4 %) had severe SA (AHI>30/h). The apnea was predominantly obstructive (32 cases vs. 12 with central SA). Comparing the patients with mild or no SA with those with severe SA, we did not find statistically significant correlations (p>0.05) between the severity of SA and the majority of main clinical and paraclinical characteristics - age, sex, BMI, cardiac substrates of heart failure, comorbidities. Paradoxically, arterial hypertension (p=0.028) and atrial fibrillation (p=0.041) were significantly more prevalent in the group with mild or no SA. Conclusions. Before discharge, in the majority of patients hospitalized with acute heart failure moderate and severe SA is present, and is not related to the majority of patient related factors. Finding of significant SA in this setting is important, because its therapy could play an important role in preventing readmissions and improving prognosis.

scholarly journals Dissecting Aneurysm of the Vertebral Artery Developed after Microvascular Decompression for Hemifacial Spasm

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 145-147 ◽  
Author(s):  
T. Kudo ◽  
K. Iihara ◽  
K. Murao ◽  
K. Hayashi ◽  
J. Ayabe ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
De Novo ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Left Vertebral Artery ◽  
Root Exit Zone ◽  
Detachable Coils ◽  
One Year

We report a rare case of a ruptured de novo dissecting aneurysm induced by ethyl 2-cyanoacrylate. A 39-year-old woman underwent microvascular decompression for left hemifacial spasm. The offending vessel was left posterior inferior cerebellar artery (PICA). Left vertebral artery (VA) was mobilized and affixed to the dura mater with cyanoacrylate to remove pressure of PICA to the root exit zone of the facial nerve. The left VA was found to be intact at the time of the operation. One year later, the patient sufferd subarachnoid haemorrhage (SAH) caused by rupture of a newly-developed dissecting aneurysm of the left VA. Endovascular occlusion of the dissecting site was performed using Guglielmi detachable coils. We suppose mechanical injury and chemical reaction of ethyl 2-cyanoacrylate induced dissecting aneurysm.

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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