Facial root entry/exit zone contact in microvascular decompression for hemifacial spasm: a historical control study
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Microvascular decompression (MVD) surgery is recognized as an effective treatment for hemifacial spasm (HFS). In MVD surgery, biocompatible materials are usually implanted in situ at the neurovascular conflict site in contact with the offending vessel and the facial root entry/exit zone (REZ). Another procedure of implanting the materials between the responsible vessel and the supraolivary fossa without REZ contact has also been applied. However, it is unclear whether there are any differences between these 2 procedures (REZ-contact procedure vs. REZ-non-contact procedure). Therefore, the aim of the present study was to investigate the effect of the placement of implants (contacting or not contacting the facial REZ) on surgical operations and outcomes.A historical control study was performed. Clinical data of HFS patients who underwent MVD between December 2016 and November 2018 were reviewed and categorized into 1 group with the REZ-contact procedure or another group with the REZ-non-contact procedure according to the decompression strategy they received. Clinical demographics, postoperative outcomes, and complications were collected and compared between the two groups.Not all patients are suitable for REZ-non-contact decompression. A total of 205 patients were enrolled: 112 in the REZ-contact group and 93 in the REZ-non-contact group. In the early postoperative period, the complete cure rate in the REZ-non-contact group was significantly higher than that in the REZ-contact group. The reappearance and partial relief rates in the REZ-contact group were significantly higher than those in the REZ-non-contact group. The incidence of short-term neurological complications, especially hearing loss and transient facial palsy, was lower in the REZ-non-contact group (P=0.043). But for long-term follow-up of >1 year, there was no significant difference between the two groups in either curative effects or neurological complications. The operating time for REZ-non-contact decompression was relatively longer than for REZ-contact decompression (P=0.000). An unexpected subdural hemorrhage occurred in the REZ-non-contact group.REZ-non-contact decompression procedure showed superiority only in short-term postoperative outcomes. Given its limitations and potential risks, the REZ-non-contact procedure can be used as an alternative individualized strategy in MVD, and there is no need to pursue REZ-non-contact during the decompression.Keywords:
Hemifacial spasm
Microvascular Decompression
Neurovascular bundle
BACKGROUND:Hemifacial spasm (HFS) is a benign, chronic, involuntary movement of the muscles involved in facial expressions that typically begins in the orbicularis oculi and spreads to the other expression muscles over several years.
Hemifacial spasm
Microvascular Decompression
Facial muscles
Orbicularis oculi muscle
Surgical decompression
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Hemifacial spasm
Microvascular Decompression
Facial muscles
Neuroradiology
Interventional radiology
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Objective To analyze the anatomical relationship between the offending vessels and the facial nerve in hemifacial spasm(HFS) and to provide anatomical basis for microvascular decompression(MVD) in patients with HFS.Methods The clinical data of 78 patients with HFS treated with MVD were analyzed retrospectively to find out whether the offending vessels existed or not and their origin and running course,and to summarize the efficacy of microvascular decompression on hemifacial spasm.Results There were offending vessels in 77 patients(98.72%)out of the 78 patients with HFS,including 39 cases(50.00%) of anterior inferior cerebellar artery(AICA),21 cases(26.93%) of posterior inferior cerebellar artery(PICA),10 cases(12.82%) of AICA and PICA,3 cases(3.85%) of PICA and vertebral artery(VA),2 cases(2.56%) of AICA and VA,and 2 cases(2.56%) of AICA,PICA and VA.1 case(1.28%) had no offending vessels.The spasm disappeared immediately after the operation in 72 patients,and the symptoms of spam improved significantly in 5 patients,who were cured in three to six months.Conclusion Vascular compression may be the main cause of HFS,and the operation of MVD for HFS could achieve satisfactory efficacy.Exposing REZ during operation,accurately identifying the offending vessels,fully decompressing of REZ,the size of graft and the location of graft are important factors influencing surgical efficacy.
Hemifacial spasm
Microvascular Decompression
Superior cerebellar artery
Cerebellar artery
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Abstract Facial muscle responses in patients with hemifacial spasm undergoing microvascular decompression operations were recorded. Two peripheral branches of the facial nerve were stimulated and the electrical responses of muscles innervated by these branches were studied to see how the lateral spread of activity that is known to be present in these patients was affected by decompressing the facial nerve. In some of the patients the hemifacial spasm ceased when the dura mater was opened, in some it ceased when the arachnoid was opened, and in others the spasm persisted until the offending vessel was dissected away from the nerve. The lateral spread of activity elicited by antidromic stimulation of a branch of the facial nerve was less affected by opening of the dura mater or arachnoid: it usually persisted until the blood vessel that had been compressing the facial nerve was removed and reappeared when the vessel that had been compressing the facial nerve was allowed to slip back onto the nerve. This seems to indicate that microvascular decompression of the facial nerve is effective in alleviating hemifacial spasm because it removes the actual cause of the disorder rather than simply causing local injury to the nerve as a result of the procedure.
Hemifacial spasm
Microvascular Decompression
Antidromic
Facial muscles
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Objective To analyze the anatomical relationship between the offending vessels of hemifacial spasm(HFS)and the facial nerve and to provide an anatomical basis for microvascular decompression(MVD)in patients with HFS.Methods The clinical data of 106 patients with HFS treated with MVD from January 2003 to August 2007 were analyzed retrospectively.All patients underwent 3D-TOF-MRA before the operation in order to find out whether the offending vessels existed or not and their origin and running course.During the operation,the root exit zone(REZ)of facial nerve was exposed through the suboccipital retrosigmoid-inferiolateral cerebellum approach.After carefully observing the offending vessels and their origin,a Teflon graft was inserted between the vessels and root exit zone of the facial nerve near the brainstem.Results 3D-TOF-MRA revealed that the positive rate of microvascular compression of facial nerve was 92%.The specific microvascular compression was found in all patients during the operation,and the anterior inferior cerebellar artery accounted for 66%(70/106)in the offending vessels.Apparente vascular impressions were found on the facial nerve at the REZ in 34 patients.The spasm resolved completely immediately after the operation in 104 patients,and the symptoms of spasm improved significantly in 2 patients,and they were cured in three months.The total effective rate was 100%.Conclusions Vascular compression may be the main cause of HFS.Exposing REZ during operation,accurately identifying the offending vessels,fully decompressing of REZ,the size of graft,and location of graft placed are the important factors of influencing surgical efficacy.Skillful microsurgical technique and accurately identifying the offending vessels during the operation,as well as properly decompressing facial nerve are the key factors in improving surgical efficacy and reducing the recurrence of symptoms.
Hemifacial spasm
Microvascular Decompression
Superior cerebellar artery
Cerebellar artery
Facial muscles
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Objective To investigate surgical effect and complication of microvascular decompression( MVD) on hemifacial spasm( HFS). Methods A retrospective analysis was conducted for 92 patients with HFS enrolled in our hospital from Feb. 2006 to Jun. 2011 accepted with MVD. Results After a follow- up of 6 months to 7 years,77 patients were cured for HFS,7 patients were alleviated,6 patients were partly alleviated 2 patients were invalided and no recurrence,suggesting a total efficiency of 97. 7%. Conclusion MVD operation is the most available treatment to HFS. Skilled microsurgical technique along with the local anatomy knowledge of cerebellopontine angle,good exposure of root exit zoon( REZ),correct recongnition of offending vascular,the appropriate size and proper positioning of Teflon grafts are important factors to assure high efficacious and reduce complications in microvascular decompression.
Hemifacial spasm
Microvascular Decompression
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Objective To discuss the efficacy of microvascular decompression(MVD) for hemifacial spasm(HFS).Methods We analyzed the clinical data of 138 cases of HFS by MVD.Through flocculonodular,the root exit zones(REZ) of the facial nerve were exposed via keyhole approach.After identifying the responsible vessels,a pad of Teflon cotton was gently interposed to maintain the separation of the REZ and the responsible vessels.Function of the acoustic nerves was monitored throughout the procedure by means of brainstem auditory evoked potential.Results Vascular compression in the facial nerve roots REZ was found in all patients.Hemifacial spasm stopped immediately after the operation in 106 patients.The post-operative symptom duration was 1 week in 20 patients,3 months in 10 patients.Facial spasm recurred in 2 cases.Five patients had delayed decreased hearing.One had hearing loss.Conclusions MVD is the most effective method for hemifacial spasm.Skilled technique of microsurgery via keyhole approach could lead to minimal operative injury.The exposure of the REZ of facial nerve roots,responsible vessels identification and Teflon insertion are the key factors which affect the efficacy of decompression.Monitoring the brainstem auditory evoked potential in operation can prevent or decrease the complications of MVD,especially dysaudia.
Hemifacial spasm
Microvascular Decompression
Keyhole
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Facial electromyographic (EMG) responses were monitored intraoperatively in 67 patients with hemifacial spasm who were operated on consecutively by microvascular decompression of the facial nerve near its exit from the brain stem. At the beginning of the operation, electrical stimulation of the temporal or the zygomatic branch of the facial nerve gave rise to a burst of EMG activity (autoexcitation) and spontaneous EMG activity (spasm) that could be recorded from the mentalis muscle in all patients. In some patients, the spontaneous activity and the autoexcitation disappeared after the dura was incised or when the arachnoid was opened, but stimulation of the temporal branch of the facial nerve caused electrically recordable activity in the mentalis muscle (lateral spread) with a latency of about 10 msec that lasted until the facial nerve was decompressed in all but one patient, in whom it disappeared when the arachnoidal membrane was opened. When the facial nerve was decompressed, this lateral spread of antidromic activity disappeared totally in 44 cases, in 16 it was much reduced, and in seven it was present at the end of the operation at about the same strength as before craniectomy. In four of these last seven patients there was still very little improvement of the spasm 2 to 6 months after the operation; these four patients underwent reoperation. In two of the remaining three patients, the spasm was absent at the 3- and 7-month follow-up examination, respectively, and one had mild spasm. Of the 16 patients in whom the lateral spread response was decreased as a result of the decompression but was still present at the end of the operation, 14 had no spasm and two underwent reoperation and had mild spasm at the last examination. Of the 44 patients in whom the lateral spread response disappeared totally, 42 were free from spasm and two had occasional mild spasm at 6 and 13 months, respectively, after the operation. Monitoring of facial EMG responses is now used routinely by the authors during operations to relieve hemifacial spasm, and is performed simultaneously with monitoring of auditory function for the purpose of preserving hearing. The usefulness of monitoring both brain-stem auditory evoked potentials recorded from electrodes placed on the scalp and compound action potentials recorded directly from the eighth cranial nerve is evaluated.
Hemifacial spasm
Microvascular Decompression
Antidromic
Facial muscles
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Citations (188)
Background: Delayed effect of microvascular decompression (MVD) in hemifacial spasm (HFS) is not uncommon one unlike MVD in trigeminal neuralgia (TN) with immediate pain relief. Final evaluation of MVD effect in HFS is possible at least one year after surgery. Intraoperative monitoring (IOM) plays a great role in identification of main offending vessels and gives confidence to the surgeon in adequacy of facial nerve (FN) decompression, saving patient from unnecessary revision surgery.
Hemifacial spasm
Microvascular Decompression
Trigeminal Nerve
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Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment. Key Words: Hemifacial spasm · Microvascular decompression surgery · Intraoperative neurophysiological monitoring.
Hemifacial spasm
Microvascular Decompression
Intraoperative neurophysiological monitoring
Facial muscles
Facial electromyography
Neurophysiology
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Citations (17)