Microvascular Decompression by the Retrosigmoid Approach for Idiopathic Hemifacial Spasm: Experience with 300 Cases

Three hundred patients with idiopathic hemifacial spasm who underwent microvascular decompression through the retrosigmoid approach are reported. Vascular compression was found in every patient on operation. The results of 1 to 6 years of follow-up show that 276 patients are free of the symptom, 4 patients have markedly diminished spasms and a decreased episode rate, 10 patients have no significant relief from the operation, and 9 have had recurrences of the symptom since the operation. The cure rate in this group is 92%. Complications were sensorineural hearing loss in 13 patients (7 temporary cases, 6 permanent), tinnitus in 7 (4 temporary cases, 3 permanent), temporary postoperative facial weakness in 16, and postoperative meningitis in 10 (9 cases were controlled with antibiotics and 1 patient died).

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A New Application of Gelatin Sponge in the Treatment of Hemifacial Spasm by Microvascular Decompression: A Technical Note

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1720994 ◽

2021 ◽

Author(s):

Bowen Chang ◽

Yinda Tang ◽

Xiangyu Wei ◽

Shiting Li

Keyword(s):

Hearing Loss ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Facial Palsy ◽

Poor Response ◽

Technical Note ◽

Gelatin Sponge ◽

Group Differences ◽

Success Rates

Abstract Objectives Microvascular decompression (MVD) for facial nerve remains the highly efficient hemifacial spasm (HFS) treatment. Nonetheless, a variety of cases have poor response to MVD. Using Teflon plus gelatin sponge in MVD seems to be a good solution. No existing study has examined the efficacy of using Teflon combined with gelatin sponge during MVD for HFS. Therefore, this study aimed to compare the efficacy of Teflon combined with gelatin sponge in HFS patients relative to that of Teflon alone. Patients and Methods We retrospectively compared the follow-up results of patients treated with Teflon and gelatin sponge with those treated with Teflon alone previously. Six hundred and eighty-eight primary HFS patients undergoing surgery from January 2010 to January 2018 were retrospectively analyzed. Three hundred and forty-seven cases received simple Teflon, while 342 cases underwent Teflon combined with gelatin sponge. Results In the Teflon plus gelatin sponge group, the incidences of facial palsy and hearing loss at 1 day, 1 year, and 2 years following surgery was significantly lower than those in the simple Teflon group. Differences in the success rates between Teflon plus gelatin sponge and the simple Teflon group were not statistically significant at 1 day, 1 year, and 2 years after surgery. The recurrence rate in the Teflon plus gelatin sponge group was significantly lower at 2 years. Conclusion For HFS patients undergoing MVD, using Teflon plus gelatin sponge can remarkably reduce the incidence of recurrence, facial palsy, and hearing loss compared with those using Teflon alone.

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Microvascular decompression for hemifacial spasm

Journal of Neurosurgery ◽

10.3171/jns.1991.75.3.0388 ◽

1991 ◽

Vol 75 (3) ◽

pp. 388-392 ◽

Cited By ~ 45

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.

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Hypertension of neurogenic origin: effect of microvascular decompression of the CN IX-X root entry/exit zone and ventrolateral medulla on blood pressure in a prospective series of 48 patients with hemifacial spasm associated with essential hypertension

Journal of Neurosurgery ◽

10.3171/2014.12.jns141775 ◽

2015 ◽

Vol 123 (6) ◽

pp. 1405-1413 ◽

Cited By ~ 15

Author(s):

Marc Sindou ◽

Mohamed Mahmoudi ◽

Andrei Brînzeu

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

High Resolution ◽

Medical Treatment ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Ventrolateral Medulla ◽

Vascular Compression ◽

Who Grade

OBJECT In spite of solid anatomical and physiological arguments and the promising results of Jannetta in the 1970s, treating essential hypertension by microvascular decompression (MVD) of the brainstem has not gained acceptance as a mainstream technique. The main reason has been a lack of established selection criteria. Because of this, the authors' attempts have been limited to patients referred for MVD for hemifacial spasm (HFS) who also had hypertension likely to be related to neurovascular compression (NVC). METHODS Of 201 patients referred for HFS, 48 (23.8%) had associated hypertension. All had high-resolution MR images that demonstrated NVC. All underwent MVD of the root exit/entry zone (REZ) of the ninth and tenth cranial nerves (CN IX-X) and adjacent ventrolateral medulla in addition to the CN VII REZ. Effects on hypertension, graded using the WHO classification, were studied up to the latest follow-up, which was 2–16 years from the time of surgery, 7 years on average. Also, effects of MVD on blood pressure (BP) according to the side of vascular compression were evaluated. RESULTS Preoperatively, hypertension was severe in all but 1 of the patients; in spite of medical treatment, 47 patients still had WHO Grade 1 or 2 hypertension, and 18 still had unstable BP. After MVD, at latest follow-up, BP had returned to normal (i.e., systolic pressure < 140 mm Hg) in 28 patients; 14 of these patients (29.10% of the whole series) were able to maintain normal BP without any antihypertensive treatment; the other 14 still required some medication to maintain their BP below 140 mm Hg (p < 0.0001). Also, at latest follow-up, BP remained unstable in only 8 of the 18 patients with instability prior to MVD (p < 0.02). Analysis according to side of compression showed that of the 30 patients with left-sided compression, 17 had their BP normalized (without medication in 11 cases), and of the 18 patients with right-sided compression, 11 had their BP normalized (without medication in 3 cases). The difference between sides was not significant. CONCLUSIONS These results argue for considering MVD for the treatment of hypertension likely to be due to NVC at the CN IX-X REZ and adjacent ventrolateral medulla. Criteria for selecting patients with hypertension alone still need to be established and could include the following indications: apparently essential hypertension, likely to be neurogenic, in patients in whom high-resolution MRI shows clear-cut images of NVC at the CN IX-X REZ and adjacent ventrolateral medulla and in whom BP cannot be controlled by medical treatment.

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Microvascular decompression for atypical hemifacial spasm: lessons learned from a retrospective study of 12 cases

Journal of Neurosurgery ◽

10.3171/2015.3.jns142501 ◽

2016 ◽

Vol 124 (2) ◽

pp. 397-402 ◽

Cited By ~ 8

Author(s):

Jiang Liu ◽

Yue Yuan ◽

Ying Fang ◽

Li Zhang ◽

Xiao-Li Xu ◽

...

Keyword(s):

Hearing Loss ◽

Facial Paralysis ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Lessons Learned ◽

Neurovascular Compression ◽

Gradual Improvement ◽

Facial Spasm ◽

Orbicularis Oris Muscle

OBJECT Typical hemifacial spasm (HFS) commonly initiates from the orbicularis oculi muscle to the orbicularis oris muscle. Atypical HFS (AHFS) is different from typical HFS, in which the spasm of muscular orbicularis oris is the primary presenting symptom. The objective of this study was to analyze the sites of compression and the effectiveness of microvascular decompression (MVD) for AHFS. METHODS The authors retrospectively analyzed the clinical data for 12 consecutive patients who underwent MVD for AHFS between July 2008 and July 2013. RESULTS Postoperatively, complete remission of facial spasm was found in 10 of the 12 patients, which gradually disappeared after 2 months in 2 patients. No recurrence of spasm was observed during follow-up. Immediate postoperative facial paralysis accompanied by hearing loss occurred in 1 patient and temporary hearing loss with tinnitus in 2. All 3 patients with complications had gradual improvement during the follow-up period. CONCLUSIONS The authors conclude that most cases of AHFS were caused by neurovascular compression on the posterior/rostral side of the facial nerve distal to the root entry zones. MVD is a safe treatment for AHFS, but the incidence of postoperative complications, such as facial paralysis and decrease in hearing, remains high.

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Microvascular Decompression in Patient With Atypical Features of Hemifacial Spasm Secondary to Compression by a Tortuous Vertebrobasilar System

Neurosurgery ◽

10.1227/01.neu.0000369518.49077.d7 ◽

2010 ◽

Vol 66 (6) ◽

pp. E1212-E1212 ◽

Cited By ~ 7

Author(s):

David H. Perlmutter ◽

Anthony L. Petraglia ◽

Richard Barbano ◽

Jason M. Schwalb

Keyword(s):

Hearing Loss ◽

Botulinum Toxin ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Cranial Nerves ◽

Vascular Compression ◽

Vertebrobasilar System ◽

The Face ◽

Grade 3 ◽

The Right

Abstract OBJECTIVE We report a case of hemifacial spasm in a patient who had associated hearing loss, numbness throughout the face, tinnitus, and vertigo, all of which occurred when turning his head to the left. To our knowledge, these symptoms have not occurred in this pattern and with a single trigger. CLINICAL PRESENTATION A 45-year-old man presented with a 3-year history of right-sided hemifacial spasm initially treated with botulinum toxin. One month before presentation, he had an episode of acute hearing loss in the right ear when turning his head to the left, followed by multiple episodes of transient hearing loss in his right ear, numbness in his right face in all distributions of the trigeminal nerve, tinnitus, and vertigo. He was found to have decreased sensation in nerves V1 to V3 and House-Brackmann grade 3/6 weakness in his right face, despite not having botulinum toxin injections in more than a year. Magnetic resonance imaging/angiography showed an ectatic vertebrobasilar system causing compression of the fifth, seventh, and eighth cranial nerves. INTERVENTION The patient underwent a retromastoid craniotomy and microvascular decompression. Postoperatively, he had complete resolution of his symptoms except for his facial weakness. The benefit has been long-lasting. CONCLUSION Multiple, simultaneous cranial neuropathies from vascular compression are rare, but this case is an example of safe and effective treatment with microvascular decompression with durable results.

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Does Intraoperative Monitoring of Auditory Evoked Potentials Reduce Incidence of Hearing Loss as a Complication of Microvascular Decompression of Cranial Nerves?

Neurosurgery ◽

10.1227/00006123-198902000-00017 ◽

1989 ◽

Vol 24 (2) ◽

pp. 257-263 ◽

Cited By ~ 70

Author(s):

Aage R. Møller ◽

Margareta B. Møller

Keyword(s):

Hearing Loss ◽

Evoked Potentials ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Auditory Evoked Potentials ◽

Cranial Nerves ◽

Hearing Threshold ◽

Speech Discrimination ◽

Compound Action Potentials

Abstract During a 14-month period, 129 individuals underwent 140 operations for microvascular decompression to relieve hemifacial spasm, disabling positional vertigo, tinnitus, or trigeminal neuralgia at our institution. Seven patients were operated upon twice on the same side and 4 were operated upon on both sides at different times. In each case, the brainstem auditory evoked potentials were monitored intraoperatively by the same neurophysiologist. In 75 of these operations, compound action potentials were also recorded from the exposed 8th nerve. Comparison of speech discrimination scores before the operation and at the time fo discharge showed that at discharge, discrimination had decreased in 7 patients by 15% or more and increased in 4 patients by 15% or more, in 2 patients by as much as 52%. Essentially similar results were obtained when preoperative speech discrimination scores were compared with results obtained from the 87 patients who returned for a follow-up visit between 3 and 6 months after discharge. Only one patient lost hearing (during a second operation to relieve hemifacial spasm). Another patient (also operated upon to relieve hemifacial spasm) suffered noticeable hearing loss postoperatively, but had recovered nearly normal hearing by 4 months after the operation. Nine patients had an average elevation of the hearing threshold for pure tones in the speech frequency range (500 to 2000 Hz) of 11 dB or more at 4 to 5 days after the operation; 8 of these had fluid in their middle ears that most likely contributed to the hearing loss. Threshold elevations occurred at 4000 Hz and 8000 Hz in 19 and 29 ears, respectively.

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Microvascular decompression for hemifacial spasm involving the vertebral artery

Acta Neurochirurgica ◽

10.1007/s00701-021-05076-8 ◽

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.

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Microvascular decompression for hemifacial spasm: long-term results from 114 operations performed without neurophysiological monitoring

Journal of Neurosurgery ◽

10.3171/jns/2008/109/9/0410 ◽

2008 ◽

Vol 109 (3) ◽

pp. 410-415 ◽

Cited By ~ 49

Author(s):

Mark Dannenbaum ◽

Bradley C. Lega ◽

Dima Suki ◽

Richard L. Harper ◽

Daniel Yoshor

Keyword(s):

Hearing Loss ◽

Effective Treatment ◽

Hemifacial Spasm ◽

Microvascular Decompression ◽

Intraoperative Monitoring ◽

Significant Risk ◽

Long Term Results ◽

Neurophysiological Monitoring ◽

History Of

Object Microvascular decompression (MVD) of the facial nerve is an effective treatment for hemifacial spasm (HFS), but the procedure is associated with a significant risk of complications such as hearing loss and facial weakness. Many surgeons advocate the use of intraoperative brainstem auditory evoked response (BAER) monitoring in an attempt to improve surgical outcomes. The authors critically assessed a large series of patients with HFS who underwent MVD without neurophysiological monitoring. Methods The authors retrospectively identified 114 consecutive patients, with a history of HFS and without a history of HFS surgery, in whom MVD was performed by a single surgeon without the use of neurophysiological monitoring. Postoperative outcomes were determined by reviewing records and through telephone interviews. At least 1 year of postoperative follow-up data were available for 91 of the 114 patients, and the median follow-up duration in all cases was 8 years (range 3 months–23 years). A Kaplan–Meier analysis showed that 86% of the patients were spasm free at 10 years postoperatively. Results There were no surgical deaths or major deficits, and complications included 1 case of postoperative deafness, 1 of permanent subtotal hearing loss, and 10 of delayed facial palsy, 2 of which did not completely resolve at last follow-up. The outcomes, rates of hearing loss, and other complications compared well with those reported in studies in which investigators used intraoperative monitoring. Conclusions The results suggest that MVD without neurophysiological monitoring is a safe and effective treatment option in patients with HFS. Although BAER monitoring may be a valuable adjunct to surgery at centers experienced with the modality, the absence of intraoperative monitoring should not prevent neurosurgeons from performing MVD in patients with HFS.

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