“Macrovascular” Decompression of Dolichoectatic Vertebral Artery Causing Hemifacial Spasm Using Goretex Sling: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. 267-268 ◽  
Author(s):  
Stephan A Munich ◽  
Jacques J Morcos
Keyword(s):  
Facial Nerve ◽  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Orbicularis Oculi ◽  
Entry Zone ◽  
Common Cause ◽  
Root Entry Zone ◽  
Offending Artery ◽  
Key Steps

Abstract Hemifacial spasm is characterized by painless and involuntary spasms of the muscles supplied by the facial nerve, most commonly involving the orbicularis oculi. The most common cause of hemifacial spasm is compression of the facial nerve's root by the anterior inferior, or posterior inferior, cerebellar arteries (AICA or PICA). However, in <1% of cases, the compression can be due to a dolichoectatic vertebral artery. Microvascular decompression using Teflon patties may be sufficient when the offending artery is small (eg, AICA or PICA). However, the size and tortuosity of the vertebral artery (especially one that is dolichoectatic) may require a more robust means of decompression (ie, “macrovascular decompression”).  In this operative video we demonstrate our technique for managing a patient with hemifacial spasm due to a dolicoectatic vertebral artery. We use a Goretex® (W.L. Gore & Associates Inc, Newark, Delaware) sling secured to the dura of the posterior petrous ridge to suspend the vertebral and posterior inferior cerebellar arteries, thereby decompressing the root entry zone of the facial nerve. Teflon felt pieces are added as a second layer of security. Key steps to this technique include: (1) visualization of the root entry zone, (2) extensive arachnoid dissection to allow adequate mobilization of the vertebral artery, 12 and (3) securing the sling in a trajectory that prevents kinking of the vertebral artery and its branches.

scholarly journals Hemifacial Spasm and Craniovertebral Anomaly

1990 ◽  
Vol 17 (4) ◽  
pp. 424-426 ◽  
Author(s):  
F.B. Maroun ◽  
J.C. Jacob ◽  
B.K.A. Weir ◽  
M.A. Mangan
Keyword(s):  
Congenital Anomaly ◽  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Craniovertebral Junction ◽  
Entry Zone ◽  
Complete Cessation ◽  
Root Entry Zone ◽  
Craniovertebral Anomaly

ABSTRACT:Two patients with congenital anomaly of the craniovertebral junction causing disabling hemifacial spasm (HFS) are presented. In one patient, complete cessation of the HFS occurred for a period of two years following simple bony decompression of the craniovertebral junction raising unanswered questions as to the exact pathogenesis of HFS. Eventually both patients required microvascular decompression at the root entry zone of the facial nerve.

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.

On the origin of synkinesis in hemifacial spasm: results of intracranial recordings

1984 ◽  
Vol 61 (3) ◽  
pp. 569-576 ◽  
Author(s):  
Aage R. Møller ◽  
Peter J. Jannetta
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Orbicularis Oculi Muscle ◽  
Orbicularis Oculi ◽  
Content Type ◽  
Root Entry Zone ◽  
Marginal Mandibular Branch ◽  
Intracranial Recordings ◽  
Mandibular Branch ◽  
Stimulation Of

✓ Recordings were made from facial muscles and the facial nerve near its entrance into the brain stem in patients with hemifacial spasm (HFS). The purpose of this study was to determine if the synkinesis commonly seen in patients with HFS could be linked to ephaptic transmission at the presumed site of the lesion (at the root entry zone (REZ) of the facial nerve). When the mandibular branch of the facial nerve was electrically stimulated, a response could be recorded from the orbicularis oculi muscles during the operation. The latency of the earliest response was 11.03 ± 0.66 msec (mean response of seven patients ± standard deviation (SD)). With equivalent stimulation a response could also be recorded from the facial nerve near the REZ; the latency of this response was 3.87 ± 0.36 msec. Stimulation of the facial nerve at the same location yielded a response from the orbicularis oculi muscle, with a latency of 4.65 ± 0.25 msec. The latency of the earliest response from the orbicularis oculi muscle to stimulation of the marginal mandibular branch of the facial nerve (11.3 msec) is thus larger than the sum of the conduction times from the points of stimulation of the marginal mandibular branch to the REZ of the facial nerve and from the REZ of the facial nerve to the orbicularis oculi muscle (8.52 ± 0.38 msec). It is therefore regarded as unlikely that the earliest response of the orbicularis oculi muscle to stimulation of the mandibular branch of the facial nerve is a result of “crosstalk” in the facial nerve at a location near the REZ, and it seems more likely that HFS caused by injury of the facial nerve is a result of reverberant activity in the facial motonucleus, possibly caused by mechanisms that are similar to kindling.

Hemifacial Spasm Caused by a Venule: Case Report

Neurosurgery ◽  
1984 ◽  
Vol 14 (1) ◽  
pp. 89-92 ◽  
Author(s):  
Peter J. Jannetta
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Blood Vessels ◽  
Hemifacial Spasm ◽  
Vascular Compression ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Facial Spasm ◽  
Posterior Direction ◽  
Anterior Posterior

Abstract The syndrome of hemifacial spasm occurs as a consequence of compression, almost universally by blood vessels, of the root entry zone of the facial nerve. The vascular compression is usually obvious at operation, but may be subtle. The author describes a case in which a venule running in an anterior-posterior direction across the caudal aspect of the root entry zone of the facial nerve, which was thought to be causing the spasm, was coagulated and divided. A small, more distal arteriole, probably not contributory, was decompressed away from the nerve. After operation, the patient improved gradually, and she remains free of facial spasm or weakness. This is the most subtle vascular compression seen by the author and his colleagues in over 400 microvascular decompressions for hemifacial spasm.

Role of Postoperative Magnetic Resonance Imaging after Microvascular Decompression of the Facial Nerve for the Treatment of Hemifacial Spasm

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 720-726 ◽  
Author(s):  
Jin Woo Chang ◽  
Jong Hee Chang ◽  
Jae Young Choi ◽  
Dong Ik Kim ◽  
Yong Gou Park ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Short Range ◽  
Three Dimensional ◽  
Resonance Imaging ◽  
Entry Zone ◽  
Root Entry Zone

Abstract OBJECTIVE: This study was performed to investigate the role of postoperative three-dimensional short-range magnetic resonance angiography in the prediction of clinical outcomes after microvascular decompression (MVD) for the treatment of hemifacial spasm. METHODS: We examined pre- and postoperative magnetic resonance imaging scans obtained between March 1999 and May 2000 for 122 patients with hemifacial spasm, to evaluate the degree of detachment of the vascular contact and changes in the positions of offending vessels. The degree of vascular decompression of the facial nerve root was classified into three groups, i.e., contact, partial decompression, or complete decompression. Contact was defined as unresolved compression, as indicated by postoperative three-dimensional short-range magnetic resonance angiography. Partial decompression was defined as incompletely resolved compression; vascular indentation of the facial nerve was improved, but contact with the facial nerve remained. Complete decompression was defined as completely resolved compression. These findings were compared with the surgical findings and clinical outcomes. RESULTS: Of 122 patients with MVD, complete decompression of offending vessels at the root entry zone of the facial nerve was observed for 106 patients (86.9%), partial decompression was observed for 10 patients (8.2%), and contact with offending vessels was observed for 6 patients (4.9%) by using postoperative three-dimensional short-range magnetic resonance angiography. Our study demonstrated that the types of offending vessels affected neither the degree of decompression of the root entry zone of the facial nerve nor surgical outcomes (P > 0.05). Also, there was no significant relationship between the degree of decompression and improvement of symptoms (P > 0.05). Furthermore, there was no significant relationship between the degree of decompression and the timing of symptomatic improvement (P > 0.05). CONCLUSION: Our data suggest that MVD of the facial nerve alone may not be sufficient to resolve symptoms for all patients with hemifacial spasm. Therefore, unknown factors in addition to vascular compression may cause symptoms in certain cases, and it may be necessary to remove those factors, simultaneously with MVD, to obtain symptom resolution.

scholarly journals Endoscopic-Assisted Microvascular Decompression of Ectatic Vertebral Artery for Hemifacial Spasm: Operative Video and Technical Nuances

2019 ◽  
Vol 80 (S 03) ◽  
pp. S312-S313
Author(s):  
James K. Liu ◽  
Vincent N. Dodson
Keyword(s):  
Facial Nerve ◽  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Lateral Spread ◽  
Microsurgical Decompression ◽  
Root Exit Zone ◽  
Hearing Function ◽  
Endoscopic Assistance ◽  
Lateral Spread Response

In this operative video atlas manuscript, the authors demonstrate the operative nuances and surgical technique for endoscopic-assisted microvascular decompression of a large ectatic vertebral artery causing hemifacial spasm. A retrosigmoid approach was performed and a large ectatic vertebral artery was transposed away from the root exit zone of cranial nerve VII (Fig. 1). The lateral spread response disappeared, signifying adequate decompression of the facial nerve (Fig. 2). The use of endoscopic-assistance during the microsurgical decompression was very useful to confirm the origin and also the resolution of neurovascular conflict. Postoperatively, the patient experienced immediate resolution of hemifacial spasm with normal facial nerve and hearing function. Written consent was obtained from the patient to publish videos, photographs, and images from the surgery.The link to the video can be found at: https://youtu.be/RlMz44uCDCw.

Endovascular Flow Diversion for Hemifacial Spasm Induced by a Vertebral Artery Aneurysm: First Experience

2018 ◽  
Vol 17 (3) ◽  
pp. E115-E118
Author(s):  
David R Santiago-Dieppa ◽  
Marin A McDonald ◽  
Michael G Brandel ◽  
Robert C Rennert ◽  
Alexander A Khalessi ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Complete Resolution ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Flow Diversion ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Flow Diverting Stent

Abstract BACKGROUND AND IMPORTANCE Flow diversion for the treatment of aneurysm-induced hemifacial spasm (HFS) has not been previously described. CLINICAL PRESENTATION The authors present the case of a 60-yr-old woman who presented with 1 yr of progressive left HFS secondary to a vertebral artery aneurysm compressing the root entry zone of cranial nerve VII. The patient's aneurysm was successfully treated with a flow diverting stent. CONCLUSION In the immediate postoperative period, the patient had near complete resolution of her HFS symptoms. At her 6-mo follow-up the patient had no angiographic filling of the aneurysm and her HFS symptoms had completely resolved.

scholarly journals Microvascular Decompression and Nervus Intermedius Sectioning for the Treatment of Geniculate Neuralgia

2018 ◽  
Vol 80 (S 03) ◽  
pp. S316-S317 ◽  
Author(s):  
Tyler J. Kenning ◽  
Christine S. Kim ◽  
Alexander G. Bien
Keyword(s):  
Vertebral Artery ◽  
Microvascular Decompression ◽  
Single Case ◽  
Anterior Inferior Cerebellar Artery ◽  
Root Entry Zone ◽  
Vertebrobasilar System ◽  
Tertiary Center ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Nervus Intermedius

Objectives Demonstrate the surgical treatment of geniculate neuralgia via microvascular decompression and nervus intermedius sectioning. Designs Single case-based operative video. Setting Tertiary center with dedicated skull base team. Participants The patient is a 62-year-old female with a history of deep right-sided otalgia consistent with geniculate neuralgia. She failed appropriate medical treatment. Her magnetic resonance imaging (MRI) showed an ectatic vertebrobasilar system as well as an anterior inferior cerebellar artery (AICA) loop causing compression of the VII/VIII nerve complex in the cerebellopontine angle. Main Outcome Measures Resolution of right-sided otalgia. Results The patient underwent retrosigmoid craniotomy with microvascular decompression of the VII/VIII nerve complex and nervus intermedius sectioning. Intraoperatively, the patient was noted to have an ectatic vertebral artery and AICA that were compressing the root entry zone of the VII/VIII nerve complex. Microvascular decompression was performed of both the vertebral artery and AICA with Teflon. The nervus intermedius was sharply sectioned. The patient's postoperative course was uneventful with no complications. She continues to have resolution of her right sided otalgia at 6 months postoperatively.The link to the video can be found at: https://youtu.be/uRb_QfrINSk.

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