scholarly journals Hemifacial spasm, neuralgia, and syncope due to cranial nerve compression in a patient with vertebral artery ectasia

2005 ◽  
Vol 76 (11) ◽  
pp. 1500-1500 ◽  
Author(s):  
K Spengos
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Cranial Nerve ◽  
Nerve Compression

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.

scholarly journals Microvascular decompression for hemifacial spasm involving the vertebral artery

2021 ◽  
Author(s):  
Jing Wang ◽  
Yulong Chong ◽  
Chengrong Jiang ◽  
Yuxiang Dai ◽  
Weibang Liang ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Surgical Outcomes ◽  
Cranial Nerve ◽  
Cure Rate ◽  
Group A ◽  
Group B

Abstract Objective Microvascular decompression (MVD) has become an accepted treatment modality for the vertebral artery (VA)–involved hemifacial spasm (HFS). The aim of this retrospective study was to evaluate clinical and surgical outcomes of HFS patients undergoing MVD and surgical and cranial nerve complications and investigate reasonable transposition procedures for two different anatomic variations of VA. Methods Between January and December 2018, 109 patients underwent first MVD for HFS involving VA at Nanjing Drum Tower Hospital. Based on whether the VA could be moved ventrally at the lower cranial nerves (LCNs) level, patients were assigned to Group A (movable VA, n = 72) or B (unmovable VA, n = 37), and clinical and surgical outcomes and complications on the day of post-surgery and during follow-up were assessed. All patients were followed up ranging from 17 to 24 months with a mean follow-up period of 21 months. Results After a mean follow-up of 21 months, the total cure rate significantly decreased in all patients compared to that achieved on the day of surgery, and Group A patients exhibited a higher cure rate versus Group B (93.1% vs. 75.7%, P = 0.015). Group B patients with unmovable VA revealed both higher incidence of surgical complications (45.9% vs. 15.3%, P = 0.001) and frequency of bilateral VA compression (27% vs. 8.3%, P = 0.009) versus Group A. No significant difference was observed in long-term cranial nerve complications. Conclusions VA-involved HFS can benefit from MVD strategies after preoperative assessment of VA compression. HFS patients with movable VA may receive better long-term efficacy and fewer complications. A Teflon bridge wedged between the distal VA and medulla gives rise to adequate space for decompression surgery.

Macrovascular Decompression of Facial Nerve With Anteromedial Transposition of a Dolichoectatic Vertebral Artery: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. E4-E4
Author(s):  
Halima Tabani ◽  
Sonia Yousef ◽  
Jan-Karl Burkhardt ◽  
Sirin Gandhi ◽  
Arnau Benet ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Cranial Nerve ◽  
Nerve Compression ◽  
Large Artery ◽  
Nerve Compression Syndromes ◽  
Vertebrobasilar Artery ◽  
Patient Consent ◽  
Compression Syndromes

Abstract Most cranial nerve compression syndromes (ie, trigeminal neuralgia and hemifacial spasm) are caused by small arteries impinging on a nerve and are relieved by microvascular decompression. Rarely, cranial nerve compression syndromes can be caused by large artery impingement and can be relieved by macrovascular decompression. When present, this compression often occurs in association with degenerative atherosclerosis in the vertebral arteries (VA) and basilar artery. Conservative treatment is recommended for mild forms, but surgical transposition of the VA away from the root entry zone (REZ) can be considered. This video demonstrates macrovascular decompression of a dolichoectatic VA in a 74-yr-old female with refractory left hemifacial spasm. After obtaining IRB approval, patient consent was sought for the procedure. With the patient in three-quarter-prone position, a far-lateral craniotomy was performed. The dentate ligament was cut to free the VA, and the suprahypoglossal portion of the vagoaccessory triangle was widened. VA compressed the REZ of the facial nerve, but was mobilized anteromedially off the REZ. A muslin sling was wrapped around the VA and its tail brought down to the clival dura, which was punctured with a 19-gauge needle and enlarged with a dissector. The sling was pulled anteromedially to this puncture site and secured to the dura with an aneurysm clip, relieving the REZ of all compression. The patient tolerated the procedure with mild, transient hoarseness and her hemifacial spasm resolved completely. This case demonstrates the macrovascular decompression technique with anteromedial transposition of the vertebrobasilar artery, which can also be used for trigeminal neuralgia.

Anchoring Method for Hemifacial Spasm Associated with Vertebral Artery: Technical Note

Neurosurgery ◽  
1999 ◽  
Vol 45 (6) ◽  
pp. 1487-1491 ◽  
Author(s):  
Kazuhiko Kyoshima ◽  
Atsushi Watanabe ◽  
Yasuyuki Toba ◽  
Junpei Nitta ◽  
Shinsuke Muraoka ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Technical Note

Microvascular Compressicaude by Slinging a Tortuous Vertebrobasilar Artery to the Petrous Dura in Hemifacial Spasm: Technical Note

2018 ◽  
Vol 37 (04) ◽  
pp. 352-361
Author(s):  
Forhad Chowdhury ◽  
Mohammod Haque ◽  
Jalal Rumi ◽  
Monir Reza
Keyword(s):  
Vertebral Artery ◽  
Free Flap ◽  
Hemifacial Spasm ◽  
Technical Note ◽  
Taxi Driver ◽  
Treatment Technique ◽  
Entry Zone ◽  
Temporal Fascia ◽  
Vertebrobasilar Artery ◽  
The Brain

Objective In cases of hemifacial spasm caused by a tortuous vertebrobasilar artery (TVBA), the traditional treatment technique involves Teflon (polytetrafluoroethylene), which can be ineffective and fraught with recurrence and neurological complications. In such cases, there are various techniques of arteriopexy using adhesive compositions, ‘suspending loops’ made of synthetic materials, dural or fascial flaps, surgical sutures passed around or through the vascular adventitia, as well as fenestrated aneurysmal clips. In the present paper, we describe a new technique of slinging the vertebral artery (VA) to the petrous dura for microvascular decompression (MVD) in a patient with hemifacial spasm caused by a TVBA. Method A 50-year-old taxi driver presented with a left-sided severe hemifacial spasm. A magnetic resonance imaging (MRI) scan of the brain showed a large tortuous left-sided vertebral artery impinging and compressing the exit/entry zone of the 7th and 8th nerve complex. After a craniotomy, a TVBA was found impinging and compressing the entry zone of the 7th and 8th nerve complex. Arachnoid bands attaching the artery to the nerve complex and the pons were released by sharp microdissection. Through the upper part of the incision, a 2.5 × 1 cm temporal fascia free flap was harvested. After the fixation of the free flap, a 6–0 prolene suture was passed through its length several times using the traditional Bengali sewing and stitching techniques to make embroidered quilts called Nakshi katha. The ‘prolenated’ fascia was passed around the compressing portion of the VA. Both ends of the fascia were brought together and stitched to the posterior petrous dura to keep the TVBA away from the 7th and 8th nerves and the pons. Result The patient had no hemifacial spasm immediately after the recovery from the anesthesia. A postoperative MRI of the brain showed that the VA was away from the entry zone of the 7th and 8th nerves. Conclusion The ‘prolenated’ temporal fascia slinging technique may be a very good option of MVD in cases in which the causative vessel is a TVBA.

Microvascular Decompression for Hemifacial Spasm Associated with Vertebral Artery: Biomedical Glue−Coated Teflon Sling Transposition Technique

2018 ◽  
Vol 120 ◽  
pp. e342-e348 ◽  
Author(s):  
Xiaofeng Jiang ◽  
Min Wu ◽  
Xianming Fu ◽  
Chaoshi Niu ◽  
Fang He ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Microvascular Decompression

Microvascular decompression of cranial nerves: lessons learned after 4400 operations

1999 ◽  
Vol 90 (1) ◽  
pp. 1-8 ◽  
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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