Treatment of Posterior Inferior Cerebellar Artery Adhesion on Petrous Bone During Microvascular Decompression Procedure for Hemifacial Spasm

2017 ◽  
Vol 28 (6) ◽  
pp. e551-e554
Author(s):  
Xiangyu Wei ◽  
Xuesheng Zheng ◽  
Shiting Li ◽  
Wenxiang Zhong ◽  
Zheng Chen
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Petrous Bone ◽  
Cerebellar Artery ◽  
Decompression Procedure

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.

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.

Follow-up results of using microvascular decompression for treatment of glossopharyngeal neuralgia

1998 ◽  
Vol 88 (2) ◽  
pp. 221-225 ◽  
Author(s):  
Akinori Kondo
Keyword(s):  
Microvascular Decompression ◽  
Posterior Inferior Cerebellar Artery ◽  
Petrous Bone ◽  
Glossopharyngeal Neuralgia ◽  
Content Type ◽  
Cerebellar Artery ◽  
Lancinating Pain ◽  
Fine Print ◽  
Partial Destruction

Glossopharyngeal neuralgia (GPN) is an uncommon disorder that is characterized by a severe lancinating pain commonly induced by swallowing. There has been some debate among various authors as to which surgical procedure should be adopted to treat cases of GPN: microvascular decompression (MVD) or partial rhizotomy. The latter necessitates the partial destruction of normal neural structures. Object. The purpose of this paper is to present follow-up results in patients with GPN who underwent MVD. Methods. Between 1980 and 1995, 20 patients underwent MVD for GPN. Results were studied to verify the effectiveness of MVD performed in 16 patients before 1991 who participated in follow-up evaluation for more than 5 years postoperatively. The follow-up period ranged from 5 to 16 years (mean ± standard deviation 11.6 ± 2.8 years). The method adopted for MVD was to reposition the offending vessel, such as a troublesome vertebral artery or posterior inferior cerebellar artery that is commonly ectatic and arteriosclerotic, by lifting the loop of the artery and using glue to affix it to the nearby dura mater of the petrous bone. Conclusions. Pain was relieved in all cases. Two patients complained of persistent mild hoarseness, causing the inability to speak loudly, and two patients complained of occasional coughing episodes that occurred for a couple of years after the surgery. No other complications were reported and no recurrence of pain was noted during the follow-up period. This procedure provided satisfactory results by preserving important perforating arteries in this area and by repositioning offending arteries in a safer and surer fashion, thus reducing complications and recurrence of GPN.

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.

Mobilization of the Anterior/Posterior Inferior Cerebellar Artery on the Cerebellar Surface in Microvascular Decompression Surgery for Hemifacial Spasm: Potential Effect on Hearing Preservation

2018 ◽  
Vol 16 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Kenichi Amagasaki ◽  
Saiko Watanabe ◽  
Atushi Hosono ◽  
Hiroshi Nakaguchi
Keyword(s):  
Hearing Impairment ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Auditory Evoked Potentials ◽  
Posterior Inferior Cerebellar Artery ◽  
Decompression Surgery ◽  
Surgical Results ◽  
Cerebellar Artery ◽  
Significant Difference ◽  
Anterior Posterior

Abstract BACKGROUND The infrafloccular approach in microvascular decompression (MVD) for hemifacial spasm (HFS) reduces the risk of postoperative hearing impairment. However, location of the anterior/posterior inferior cerebellar artery (AICA/PICA) on the cerebellar surface in the surgical route requires mobilization to maintain the approach direction for the protection of hearing function. OBJECTIVE To evaluate the effectiveness of mobilization of the AICA/PICA on the cerebellar surface in the surgical route. METHODS Retrospective review of 101 patients dividing their cases into 2 groups, the mobilized group and nonmobilized group. Surgical results, brainstem auditory evoked potentials (BAEPs), age, and duration of microsurgery were compared. In the mobilized group, whether the artery was responsible for the HFS or not, and whether the artery branched perforators to the cerebellar surface or choroid plexus or not, were analyzed. RESULTS No permanent hearing impairment occurred in any patient. The AICA/PICA was mobilized in 26 patients. No significant difference was found in surgical results, BAEP findings, and duration of microsurgery between the 2 groups, but age was younger in the mobilized group (P < .01). The mobilized artery was responsible in 14 cases and branched perforators in 7 cases in the mobilized group. The perforators did not obstruct mobilization. CONCLUSION Mobilization of the AICA/PICA from the cerebellar surface is a useful technique to maintain the infrafloccular approach in MVD for HFS. This technique reduces the risk of postoperative hearing impairment.

Hemifacial Spasm: Endoscopic Vascular Decompression

1997 ◽  
Vol 117 (4) ◽  
pp. 308-314 ◽  
Author(s):  
J. Magnan ◽  
F. Caces ◽  
P. Locatelli ◽  
A. Chays
Keyword(s):  
Hemifacial Spasm ◽  
Marked Improvement ◽  
Cerebellopontine Angle ◽  
Posterior Inferior Cerebellar Artery ◽  
Endoscopic Examination ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
The Mean ◽  
Vascular Decompression

Sixty patients with primitive hemifacial spasm were treated by means of a minimally invasive retrosigmoid approach in which endoscopic and microsurgical procedures were combined. Intraoperative endoscopic examination of the cerebellopontine angle showed that for 56 of the patients vessel-nerve conflict was the cause of hemifacial spasm. The most common offending vessel was the posterior inferior cerebellar artery (39 patients), next was the vertebral artery (23 patients), and last was the anterior inferior cerebellar artery (16 patients). Nineteen of the patients had multiple offending vascular loops. In one patient, another cause of hemifacial spasm was an epidermoid tumor of the cerebellopontine angle. For three patients, it was not possible to determine the exact cause of the facial disorder. Follow-up information was reviewed for 54 of 60 patients; the mean follow-up period was 14 months. Fifty of the patients were in the vessel-nerve conflict group. Forty of the 50 were free of symptoms, and four had marked improvement. The overall success rate was 88%, and there was minimal morbidity (no facial palsy, two cases of severe hearing loss).

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