Hemifacial Spasm: Treatment by Microsurgical Facial Nerve Decompression

Neurosurgery ◽  
1983 ◽  
Vol 13 (2) ◽  
pp. 141-146 ◽  
Author(s):  
John D. Loeser ◽  
James Chen
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Surgical Therapy ◽  
Hemifacial Spasm ◽  
Surgical Patients ◽  
Facial Weakness ◽  
Nerve Decompression ◽  
The Brain ◽  
Facial Nerve Decompression

Abstract The literature on hemifacial spasm and its surgical therapy is reviewed, and the authors' experiences with 20 patients are described. Vascular cross compression of the facial nerve adjacent to the brain stem is seen in 90% of the surgical patients. Mobilizing the offending vessel will cure or significantly improve approximately 80% of the patients. Complications occur in 25% of the patients and usually involve decreased hearing or facial weakness. Mortality is virtually zero, and this operation is vastly superior to any other medical or surgical therapy for hemifacial spasm. The pathophysiology is not yet understood.

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.

Acute Otitis Media and Facial Paralysis in Children

1996 ◽  
Vol 105 (1) ◽  
pp. 58-62 ◽  
Author(s):  
Clark A. Elliott ◽  
George H. Zalzal ◽  
Wendy R. Gottlieb
Keyword(s):  
Facial Nerve ◽  
Otitis Media ◽  
Facial Paralysis ◽  
Acute Otitis Media ◽  
Complete Recovery ◽  
Rapid Improvement ◽  
Nerve Decompression ◽  
Complete Paralysis ◽  
Prolonged Recovery ◽  
Facial Nerve Decompression

We reviewed 10 children who presented with facial paralysis after the onset of acute otitis media. The objective of the study was to examine the outcome of facial paralysis in children with acute otitis media treated without facial nerve decompression. Two groups were identified: 8 patients with incomplete paralysis and 2 with complete paralysis. Seven of the 8 patients with incomplete paralysis had rapid return of function after myringotomy and intravenous antibiotics. The eighth patient had delayed recovery requiring 9 months before complete return of function. The 2 patients with complete paralysis required mastoidectomy to control otorrhea and fever after initial myringotomy and antibiotics. Both patients had a prolonged recovery requiring 3 and 7 months for complete recovery. Patients with incomplete paralysis generally show rapid improvement following wide myringotomy and antibiotic treatment. A more protracted recovery may be expected in patients with complete paralysis; excellent return of function is expected when mastoidectomy without facial nerve decompression is employed.

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