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

2016 ◽  
Vol 124 (2) ◽  
pp. 397-402 ◽  
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.

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

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.

scholarly journals Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations

2016 ◽  
Vol 124 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Mark Gregory Bigder ◽  
Anthony M. Kaufmann
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Senior Author ◽  
Decompression Surgery ◽  
Neurovascular Compression ◽  
Exit Point ◽  
Root Exit Zone ◽  
Prior Surgery ◽  
Microvascular Decompression Surgery

OBJECT Microvascular decompression (MVD) surgery for hemifacial spasm (HFS) is potentially curative. The findings at repeat MVD in patients with persistent or recurrent HFS were analyzed with the aim to identify factors that may improve surgical outcomes. METHODS Intraoperative findings were determined from review of dictated operative reports and operative diagrams for patients who underwent repeat MVD after prior surgery elsewhere. Clinical follow-up was obtained from the hospital and clinic records, as well as telephone questionnaires. RESULTS Among 845 patients who underwent MVD performed by the senior author, 12 had been referred after prior MVD for HFS performed elsewhere. Following repeat MVD, all patients improved and complete spasm resolution was described by 11 of 12 patients after a mean follow-up of 91 ± 55 months (range 28–193). Complications were limited to 1 patient with aggravation of preexisting hearing loss and mild facial weakness and 1 patient with aseptic meningitis without sequelae. Significant factors that may have contributed to the failure of the first surgery included retromastoid craniectomies that did not extend laterally to the sigmoid sinus or inferiorly to the posterior fossa floor in 11 of 12 patients and a prior surgical approach that focused on the cisternal portion of the facial nerve in 9 of 12 patients. In all cases, significant persistent neurovascular compression (NVC) was evident and alleviated more proximally on the facial root exit zone (fREZ). CONCLUSIONS Most HFS patients will achieve spasm relief with thorough alleviation of NVC of the fREZ, which extends from the pontomedullary sulcus root exit point to the Obersteiner-Redlich transition zone.

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

Neurosurgery ◽  
1989 ◽  
Vol 24 (2) ◽  
pp. 257-263 ◽  
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.

Treatment of Tic Douloureux and Hemifacial Spasm by Posterior Fossa Exploration: Therapeutic Implications of Various Neurovascular Relationships

Neurosurgery ◽  
1984 ◽  
Vol 14 (4) ◽  
pp. 462-471 ◽  
Author(s):  
H. Piatt Joseph ◽  
H. Wilkins Robert
Keyword(s):  
Posterior Fossa ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Symptomatic Relief ◽  
Effective Alternative ◽  
Neurovascular Compression ◽  
Entry Zone ◽  
Therapeutic Implications ◽  
Tic Douloureux

Abstract A series of 152 posterior fossa explorations for tic douloureux and hemifacial spasm has been reviewed with assessment of outcome at the last follow-up examination. Among 103 cases of tic followed for an average of 48.3 months. 79 patients (77%) obtained good or excellent symptomatic relief, and there were 24 failures or recurrences (23%). Of 48 cases of hemifacial spasm followed for an average of 42.1 months, there were good or excellent results in 42 cases (87.5%); only 6 patients (12.5%) experienced failure or recurrence. Patients noted to have arterial contact at the 5th nerve entry zone responded significantly better to microvascular decompression than did patients with no arterial contact. Further, patients noted to have anatomical distortion of the 5th nerve by an artery or wedging of an artery into the crevice between the nerve and the pons had significantly better outcomes after microvascular decompression than did patients with other kinds of arterial contact. Partial sensory rhizotomy proved to be a highly effective alternative to microvascular decompression in cases of doubtful neurovascular compression. It was not possible to define similar neuroanatomical criteria predictive of response to microvascular decompression in patients with hemifacial spasm.

Microvascular decompression of cranial nerves: lessons learned after 4400 operations

1998 ◽  
Vol 5 (5) ◽  
pp. E1 ◽  
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 ◽  
Cranial Nerves ◽  
Lessons Learned ◽  
Glossopharyngeal Neuralgia ◽  
Complication Rates ◽  
Csf Leakage

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.

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

2008 ◽  
Vol 109 (3) ◽  
pp. 410-415 ◽  
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.

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

1995 ◽  
Vol 104 (8) ◽  
pp. 610-612 ◽  
Author(s):  
Kai-wen Zhang ◽  
Zi-ting Shun
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Retrosigmoid Approach ◽  
Vascular Compression ◽  
Cure Rate ◽  
Facial Weakness ◽  
Postoperative Meningitis

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).

scholarly journals Penetrating Offending Vessel, The Most Surgically Demanding Type during Microvascular Decompression Surgery in Hemifacial Spasm

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Seunghoon Lee ◽  
Kwan Park
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Decompression Surgery ◽  
Neurovascular Compression ◽  
Extent Of Surgery ◽  
Free Running ◽  
The One ◽  
Microvascular Decompression Surgery

Abstract INTRODUCTION Microvascular decompression (MVD) is the most effective and curative treatment option for neurovascular compression syndrome and it is increasingly performed around the world. This study aimed to identify and describe the most technically difficult cases, which were the patients with penetrating offending vessel through the facial nerve, from our experiences and to give surgical tips for the successful MVD. METHODS Surgical records and intraoperative video of hemifacial spasm patients with penetrating offending vessels were reviewed. Interposition of Teflon felt between nerve and vessel was pursued, and neurectomy was avoided as much as possible. RESULTS Five patients with hemifacial spasm were identified as having a penetrating offending vessel through the facial nerve during the last 5 yr of MVD surgery in our institution. Four AICAs and one PICA were the causative vessels. Partial neurectomy was required in 1 patient. During the median follow-up of 6 mo (range, 1-26), all patients were spasm-free. No patients including the one with partial neurectomy were involved in facial palsy or hearing loss. CONCLUSION MVD in HFS patients with penetrating offending vessel through the facial nerve is the most surgically challenging and demands a high surgical skill. Interposition with Teflon felt is effective and neurectomy should be avoided. Intraoperative monitoring of free-running EMG and abnormal muscle response are helpful to decide the extent of surgery.

Microvascular decompression for hemifacial spasm: postoperative neurologic follow-up and evaluation of life quality

2007 ◽  
Vol 14 (3) ◽  
pp. 335-340 ◽  
Author(s):  
K. Heuser ◽  
E. Kerty ◽  
P. K. Eide ◽  
M. Cvancarova ◽  
E. Dietrichs
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Life Quality

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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