Anterior artery release, distraction and fusion (ARDF) for radiculopathy caused by a vertebral artery loop

Background Anomalous vertebral artery (VA) with loop formation is a rare cause of cervical nerve root compression. Various techniques with anterior and posterior approaches have been described for surgical treatment once conservative treatments fail. We herein present a case treated with the new technique of anterior release, distraction and fusion (ARDF) and further provide an updated review of surgically managed VA loops in the subaxial spine. Case description A 76-year-old female complained of a 6-year history of pulsating, shooting pain in her right arm to the thumb. After obtaining repeated MRI, the VA loop compressing the right-sided C6-nerve root was detected. A neurovascular decompression through ARDF which led to an indirect loop straightening was performed. The patient immediately improved after surgery and remained pain-free 1 year postoperative. Conclusion Neural irritation due to VA loop formation is a rare cause of cervical radiculopathy. While various surgical strategies have been described, we believe that anterior and anterolateral approaches are the safest to yield neurovascular decompression. We described and documented ARDF (anterior VA release, intervertebral distraction and fusion) on a patient case. Level of evidence II (Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding).

Efficacy and Complications of Microsurgical Neurovascular Decompression in 55 Patients With Hemifacial Spasm

Objective To analyze the efficacy and complications of microvascular decompression for hemifacial spasm. Study Design Retrospective study. Setting Regional hospital. Methods Fifty-five patients with hemifacial spasm were treated by microvascular decompression. All patients with hemifacial spasm who underwent retrosigmoid microvascular decompression from May 2004 to January 2017 were included. Patients with no conflict on preoperative magnetic resonance imaging or with an alternate diagnosis were excluded. Results The overall cure rate was 83.64%, with an average follow-up of 7.4 years. A left-sided hemifacial spasm was a healing-promoting factor ( P = .01). The median healing was 0.03 months, and the mean was 6 months. The efficacy remained high in the medium term (88% at 3 years), long term (90.24% at 5 years), and very long term (90.48% at 8 years). The recurrence rate was 9.8%. Favorable criteria included a right-sided spasm ( P = .01) and an average age of 62 years ( P = .03). The specific complications were permanent facial palsy (3.63%), unilateral deafness (5.45%), and hearing loss (3.63%). No death was reported. Regarding the quality of life of the patients, 94.7% had a modified HFS-8 postoperative score of 0 (Hemifacial Spasm 8 Quality of Life Scale). Conclusion Microvascular decompression for hemifacial spasm is an effective and lasting technique. Its low rate of complications and the considerable quality-of-life improvement should lead surgeons to propose it to patients as soon as botulinum toxin injections become ineffective or poorly tolerated.

Neurovascular Decompression for Trigeminal Neuralgia in 17-year-old Girl

Trigeminal neuralgia in general is a disease of the elderly. Rarely, the disease presents during childhood. Therefore we sought to explore the role of vascular compression in pediatric patients with medically refractory trigeminal neuralgia. A case of venous compression related to trigeminal neuralgia is presented in a 17-year-old girl. Upper petrous vein was found to be related to aneurovascular conflict with unusual response to neurovascular decompression with complete resolution of symptoms in postoperativeperiod.