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Wei JS, Hu X, Xia L, Shang J, Han Q, Zhang DY. Evaluation of the effect of botulinum toxin A on the physical and mental health of patients with hemifacial spasm. Neurologia 2024; 39:540-548. [PMID: 39232591 DOI: 10.1016/j.nrleng.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/23/2021] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Hemifacial spasm (HFS) is a debilitating disease characterized by involuntary tonic and clonic contractions of muscles innervated by the facial nerve. Botulinum toxin A (BTX-A) is the first-line option and the most effective medical treatment for HFS. The objective of this study was to evaluate the effect of BTX-A therapy on the physical and mental health of HFS patients. METHODS Participants included 65 HFS patients and 65 matched healthy controls in the study. Cornell Medical Index (CMI) self-assessment questionnaire was used to detect the psychological health of all participants. Local injection of BTX-A was applied, and the Cohen hierarchical criteria were employed to stratify the degree of spasticity, further evaluating the efficacy of BTX-A before and two months after treatment in HFS patients. The HFS patients at two months post-treatment were re-evaluated by CMI self-assessment questionnaire, and the evaluated factors of these patients were compared with those of patients before treatment. RESULTS The scores of somatization, depression, anxiety, inadaptation, sensitivity, anger, tension, M-R, and total scores in the HFS group were significantly higher than those in the control group (all P<0.05). Two months post-treatment, among 65 HFS patients who received with BTX-A treatment, 42 (64.6%) were completely relieved, 16 (24.6%) were significantly relieved, 7 (10.8%) were partially relieved, and 0 (0%) cases were invalid, and the total effective rate was 89.2%. Two months after BTX-A treatment, the scores of somatization, tension, anxiety, depression, sensitivity, M-R and total scores of patients with HFS were lower than those before treatment (all P<0.05). CONCLUSIONS Patients with HFS are often accompanied by somatization, anger, inadaptation, sensitivity, anxiety, depression, and tension. BTX-A can not only alleviate the symptoms of HFS, but also improve the somatization, tension, anxiety, depression, and sensitivity.
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Affiliation(s)
- J S Wei
- Department of Neurology, Hongze Huaian District People's Hospital, Huaian 223100, China
| | - X Hu
- Department of Neurology, The Second People's Hospital of Huai'an, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an 223002, China
| | - L Xia
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, China
| | - J Shang
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, China
| | - Q Han
- Department of Neurology, Huai'an First People's Hospital, the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, China.
| | - D Y Zhang
- Department of Radiology, Huai'an First People's Hospital, the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, China.
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Liu M, Hou X, Chen F, Li T, Xu Z, Li S, Zhou Y, Wang Y, Xia L, Wang W. Predictive nomogram for hearing deficits after microvascular decompression treatment. Neurosurg Rev 2024; 47:481. [PMID: 39186095 DOI: 10.1007/s10143-024-02716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/14/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
We explored the impact of brainstem auditory evoked potentials monitoring, as well as anatomical characteristics, in relation to their influence on hearing deficits. A total of 851 patients diagnosed with idiopathic hemifacial spasm underwent microvascular decompression treatment were recruited in our study. A nomogram was developed based on the regression analysis. Nomogram performance was evaluated through receiver operating characteristic (ROC), decision curve analyses and calibration curve. The rate of positive wave V change was also higher in the hearing deficit group (71.8% vs no hearing deficit group, p < 0.001). Furthermore, greater retraction depth (0.78 ± 0.25 cm vs 0.55 ± 0.12 cm, p < 0.001), duration (74.43 ± 15.74 min vs 55.71 ± 7.01 min, p < 0.001) and retraction distance (4.38 ± 0.38 cm vs 4.17 ± 0.24 cm, p = 0.001) were evident in the hearing deficit patients. Multivariate logistic regression showed that positive wave V change (OR 5.43), greater retraction depth (OR 55.57) and longer retraction duration (OR 1.14) emerged as significant independent predictors of postoperative hearing deficit. The external validation cohort exhibited a favorable discrimination with an AUC of 0.88. The calibration curves further confirmed the reliability of the predicted outcome in relation to the observed outcome in the external validation cohort (p = 0.89). The decision curves demonstrated that the nomogram outperformed the All or None scheme when the threshold probability ranged from > 2% to < 60% in the external validation cohort. We constructed a nomogram, including wave V, retraction depth, and retraction duration, which can effectively predict the occurrence of hearing deficits and has good clinical applicability.
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Affiliation(s)
- Mingxing Liu
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Xiaoqun Hou
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Feng Chen
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Tong Li
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Zhiming Xu
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Shengli Li
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Yong Zhou
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Yongyi Wang
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Lei Xia
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, 1665 KongJiang Rd, Shanghai, 200092, P. R. China.
| | - Weimin Wang
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China.
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Fu W, Liang Q, Si M, Wang K, Li W, Ma X, Guo X. Application of the semidiving technique in fully endoscopic microvascular decompression. Neurosurg Rev 2024; 47:462. [PMID: 39174761 DOI: 10.1007/s10143-024-02715-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/13/2024] [Accepted: 08/18/2024] [Indexed: 08/24/2024]
Abstract
Microvascular decompression (MVD) is the preferred treatment for hemifacial spasm (HFS) and trigeminal neuralgia (TN), and fully endoscopic microvascular decompression (E-MVD) has been widely discussed in recent years. Considering the endoscopic diving technique used in endoscopic transsphenoidal pituitary adenoma resection, we developed the endoscopic semidiving technique. This technique involves preserving some cerebrospinal fluid (CSF) and positioning the endoscope at an appropriate distance from it; the potential advantages include reducing cerebellar retraction, accurately identifying the responsible vessels and minimizing mechanical damage. This study aimed to preliminarily evaluate the safety and feasibility of the semidiving technique in E-MVD. A total of 359 patients with HFS and TN scheduled to undergo E-MVD were included in the study. Patients with each disease were divided into a nonsemidiving technique group and a semidiving technique group. Surgical data, postoperative outcomes, complications, and recurrence rates were compared between the groups. In patients with HFS, the effective rate was 95.6% (nonsemidiving)and 92.9% (semidiving) respectively, with no statistically significant difference. The semidiving technique group had a lower incidence of postoperative permanent hearing loss compared with the nonsemidiving technique group (0% vs. 5.9%). In TN patients, no significant differences in effectiveness or postoperative complications were observed. The application of the semidiving technique in E-MVD for HFS not only ensures surgical quality and postoperative efficacy but also reduces the incidence of postoperative hearing loss, shortens the surgical duration and reduces the number of postoperative hospitalization days, aligning with the concept of enhanced recovery after surgery (ERAS).
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Affiliation(s)
- Weitao Fu
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong, China
| | - Qinghshun Liang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong, China
| | - Mingbin Si
- Department of Neurosurgery, Jinan Third People's Hospital, Jinan, Shandong, China
| | - Kaili Wang
- Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Weiguo Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong, China
| | - Xiangyu Ma
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong, China.
| | - Xing Guo
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine, Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong, China.
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Hou Y, Liang H, Fan C, Liu R, Feng Y. Transcutaneous electrical acupoint stimulation to prevent dizziness after microvascular decompression for hemifacial spasm: A randomized controlled trial. Complement Ther Med 2024; 83:103055. [PMID: 38782080 DOI: 10.1016/j.ctim.2024.103055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/25/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Dizziness often occurs after microvascular decompression (MVD), and therapeutic options are limited. The aim of this trial was to determine the potential efficacy of transcutaneous electrical acupoint stimulation (TEAS), against dizziness and its safety in patients undergoing MVD. METHODS Adult patients scheduled to undergo MVD for hemifacial spasm under total intravenous anesthesia were randomized at a 1:1 ratio to receive, after extubation, 30-min TEAS in the mastoid region as well as Fengchi acupoints (GB20) and Neiguan acupoints (PC6) or 30-min sham stimulation. The primary outcome was the incidence of dizziness at 2 h after surgery. Secondary outcomes included dizziness, postoperative nausea and vomiting (PONV) or headache severity, rescue medication, changes in intraocular pressure before and after surgery, length of stay, dizziness symptoms 4 weeks after discharge, and surgical complications. RESULTS A total of 86 patients (51.9 ± 9.4 years of age; 67 women) were enrolled. One patient (in the TEAS arm) was excluded from analysis due to conversion to sevoflurane anesthesia. The rate of dizziness at 2 h after surgery was 31.0 % (13/42) in the TEAS arm vs. 53.5 % (23/43) in the sham control arm (P = 0.036). TEAS was also associated with significantly lower severity of dizziness, based on a 10-point scale, during the first 24 h after surgery. None of the other secondary efficacy outcomes differed significantly between the two arms. All postoperative complications were Clavien-Dindo grade I or II. The rate of postoperative complications was 21.4 % (9/42) in the TEAS arm vs. 16.3 % (7/43) in the sham control arm (P = 0.544). CONCLUSIONS Compared with sham control, TEAS was associated with a lower incidence of dizziness within 2 h and lower severity of dizziness within 24 h post-operatively, but no improvement in other outcomes, in adult patients undergoing MVD for hemifacial spasm.
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Affiliation(s)
- Yuantao Hou
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Hansheng Liang
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Cungang Fan
- Department of Neurosurgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Ruen Liu
- Department of Neurosurgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China; Department of Pain Medicine, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China; Key Laboratory for Neuroscience, Ministry of Education/National Health Commission of China, Peking University, Beijing, China.
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Rhomberg T, Eördögh M, Lehmann S, Schroeder HWS. Endoscope-assisted microvascular decompression in hemifacial spasm with a teflon bridge. Acta Neurochir (Wien) 2024; 166:239. [PMID: 38814504 PMCID: PMC11139744 DOI: 10.1007/s00701-024-06142-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/17/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Microvascular conflicts in hemifacial spasm typically occur at the facial nerve's root exit zone. While a pure microsurgical approach offers only limited orientation, added endoscopy enhances visibility of the relevant structures without the necessity of cerebellar retraction. METHODS After a retrosigmoid craniotomy, a microsurgical decompression of the facial nerve is performed with a Teflon bridge. Endoscopic inspection prior and after decompression facilitates optimal Teflon bridge positioning. CONCLUSIONS Endoscope-assisted microsurgery allows a clear visualization and safe manipulation on the facial nerve at its root exit zone.
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Affiliation(s)
- Thomas Rhomberg
- Department of Neurosurgery and Neurorestoration, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria.
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany.
| | - Márton Eördögh
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Sebastian Lehmann
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
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Shen L, Yang J, Cheng R, Yue C, Wang T, Chai S, Cai Y, Zhou Y, Xu D, Lei Y, Wang M, Mei Z, Zhao J, Dai X, Yang B, Chen J, Yu Y, Xiong N. Bridge-layered decompression technique for vertebral artery-involved hemifacial spasm: technical note. BMC Surg 2024; 24:154. [PMID: 38745320 PMCID: PMC11092177 DOI: 10.1186/s12893-024-02415-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Hemifacial spasm (HFS) is most effectively treated with microvascular decompression (MVD). However, there are certain challenges in performing MVD for HFS when the vertebral artery (VA) is involved in compressing the facial nerve (VA-involved). This study aimed to introduce a "bridge-layered" decompression technique for treating patients with VA-involved HFS and to evaluate its efficacy and safety to treat patients with HFS. METHODS A single-center retrospective analysis was conducted on the clinical data of 62 patients with VA-involved HFS. The tortuous trunk of VA was lifted by a multi-point "bridge" decompression technique to avoid excessive traction of the cerebellum and reduce the risk of damage to the facial-acoustic nerve complex. To fully decompress all the responsible vessels, the branch vessels of VA were then isolated using the "layered" decompression technique. RESULTS Among the 62 patients, 59 patients were cured immediately after the surgery, two patients were delayed cured after two months, and one had occasional facial muscle twitching after the surgery. Patients were followed up for an average of 19.5 months. The long-term follow-up results showed that all patients had no recurrence of HFS during the follow-up period, and no patients developed hearing loss, facial paralysis, or other permanent neurological damage complications. Only two patients developed tinnitus after the surgery. CONCLUSION The "bridge-layered" decompression technique could effectively treat VA-involved HFS with satisfactory safety and a low risk of hearing loss. The technique could be used as a reference for decompression surgery for VA-involved HFS.
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Affiliation(s)
- Lei Shen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Jingyi Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Runqi Cheng
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Chuqiao Yue
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Tiansheng Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Songshan Chai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Yuankun Cai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Yixuan Zhou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Dongyuan Xu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Yu Lei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Mengyang Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Zhimin Mei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Jingwei Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Xuan Dai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Bangkun Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Yanbing Yu
- Department of Neurosurgery, Sino-Japanese Friendship Hospital, Beijing, 100029, China.
| | - Nanxiang Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China.
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Owashi E, Ohmura K, Shoda K, Yamada T, Kano K, Nakayama N, Iwama T. Comparison of transposition and interposition methods in microvascular decompression for hemifacial spasm: an analysis of 109 cases performed by a single surgeon in a single-center retrospective study. Acta Neurochir (Wien) 2024; 166:213. [PMID: 38740614 DOI: 10.1007/s00701-024-06111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Microvascular decompression (MVD), the standard surgical approach for hemifacial spasm (HFS), can be divided into the interposition and transposition methods. Although the risk of HFS recurrence following interposition has been reported, there is limited data comparing long-term outcomes between both methods performed by a single surgeon. This study aimed to investigate the efficacy of MVD techniques on HFS by comparing surgical outcomes performed by a single surgeon in a single-center setting. METHODS A total of 109 patients who underwent MVD were analyzed and divided into the transposition (86 patients) and interposition (23 patients) groups. Postoperative outcomes at 1 month and 1 year were assessed and compared, including rates of spasm relief, complications, and recurrence. RESULTS Outcome assessment revealed higher rates of early spasm relief in the interposition group (66.3% vs. 100%, transposition vs. interposition, respectively, p = 0.0004), although spasm relief at 1-year postoperatively was comparable between the two groups (84.9% vs. 95.7%, transposition vs. interposition, respectively, p = 0.2929). No significant differences were observed in complication and recurrence rates. Kaplan-Meier analysis demonstrated no significant differences in the duration of spasm resolution by MVD method (p = 0.4347, log-rank test). CONCLUSION This study shows that both the transposition (Surgicel® and fibrin glue) and interposition (sponge) methods were excellent surgical techniques. The interposition method may achieve earlier spasm resolution compared to the transposition method.
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Affiliation(s)
- Etsuko Owashi
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazufumi Ohmura
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kenji Shoda
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tetsuya Yamada
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kiyomitsu Kano
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Noriyuki Nakayama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.
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Xiao Y, He J. Analyzing the application of dezocine combined with psychological care in the postoperative pain management of patients with hemifacial spasm. Int J Neurosci 2024:1-8. [PMID: 38602339 DOI: 10.1080/00207454.2024.2341919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/07/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To analyze the application of Dezocine combined with psychological care in the postoperative pain management. METHODS This is a retrospective study. A total of 186 HFS patients who underwent Microvascular Decompression (MVD) at First People's Hospital of Zunyi between January 2020 and January 2022 were selected as the study subjects. Patients were divided into two groups based on different treatment interventions. The control group (n = 93) received routine perioperative care without preemptive analgesia, while the observation group (n = 93) received preemptive analgesia and combined psychological care on the basis of the control group's intervention. RESULTS At 30 min post-laryngeal mask removal (T3), no significant difference in Ramsay Sedation Scale scores existed between control and observation groups (p > 0.05). The observation group showed significantly lower RSS scores at immediate mask removal (T2) and VAS scores at T3 compared to controls (p < 0.05). Following intervention, the observation group had notably lower SAS and SDS scores than controls (p < 0.05). Baseline (T0) and 5 min pre-removal (T1) exhibited no significant differences in mean arterial pressure (MAP) and heart rate (HR) values between groups (p > 0.05). However, at T2 and T3, the observation group displayed significantly lower MAP and HR values than controls (p < 0.05). No significant differences in pulse oxygen saturation (SpO2) values existed between groups at any time point (p > 0.05). CONCLUSION Compared to standard perioperative care alone, Dezocine combined with preemptive analgesia and psychological care effectively reduces postoperative pain during the awakening period, lowers the risk of immediate extubation-related agitation, and maintains stable hemodynamics in the postoperative period.
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Affiliation(s)
- Ying Xiao
- Department of Neurosurgery, First People's Hospital of Zunyi City, Guizhou Province, China
| | - Jiqiong He
- Department of Stomatology, First People's Hospital of Zunyi City, Guizhou Province, China
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Iwasaki A, Kobayashi M, Hirata S, Takabatake K, Ujihara M, Fujimaki T. A Case of Unilateral Facial Spasm With Vulnerable Hearing Function Due to a History of Cisplatin Treatment, Resulting in Intraoperative Hearing Loss. Cureus 2024; 16:e53695. [PMID: 38455770 PMCID: PMC10918615 DOI: 10.7759/cureus.53695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
A 51-year-old man with a history of cisplatin treatment for a right testicular tumor underwent microvascular decompression for hemifacial spasm. At an early stage in the surgical procedure, the intraoperative auditory brainstem response (ABR) was diminished despite a relatively minimally invasive approach, resulting in irreversible hearing loss. Cisplatin is known to cause dose-dependent hearing impairment primarily affecting the cochlea, but it can also induce neurotoxicity. In the present case, prior cisplatin administration may have caused fragility of the cochlear nerve as well. Patients with a history of ototoxic and neurotoxic drugs such as cisplatin require more careful manipulation and thorough intraoperative auditory monitoring during neurosurgical procedures that may affect hearing, such as those for hemifacial spasms.
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Affiliation(s)
- Akina Iwasaki
- Neurosurgery, Saitama Medical University Hospital, Saitama, JPN
| | | | - Sachiko Hirata
- Neurosurgery, Saitama Medical University Hospital, Saitama, JPN
| | | | - Masaki Ujihara
- Neurosurgery, Saitama Medical University Hospital, Saitama, JPN
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Zhenzhu L, Jingfeng Z, Wei Z, Jianjun Z, Yinshui X. A novel non-segmented inverted water outline rendering method can improve the tracking of responsible blood vessels for hemifacial spasm. Front Neurosci 2024; 18:1296019. [PMID: 38352044 PMCID: PMC10861737 DOI: 10.3389/fnins.2024.1296019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
This study aimed to explore a novel, non-segmented based on inverted water outline, and rapid 3D rendering method for identifying the responsible blood vessels for hemifacial spasm. First, the software was developed using the free and open-source 3D Slicer to process magnetic resonance images. Outlines of the water region were extracted and rendered in a three-dimensional space. The traditional image re-slicing technique (IMRT) was used for the control group, while non-segmented inverted water outline rendering (NSIWR) was used to observe the relevant blood vessels in the root entry/exit zone (REZ) of patients with hemifacial spasm. The intraoperative exploration results were considered the gold standard for comparing the differences in identifying relevant blood vessels between the two methods. Twenty-five patients were included, and the reconstruction effect evaluation suggested that NSIWR could effectively reconstruct the responsible blood vessels of the cochlea, facial nerve, and REZ. Compared with IMRT, NSIWR effectively improved the diagnosis of the responsible blood vessels in the REZ, clarified their sources and directions, and was consistent with intraoperative results. This study introduced a novel rapid rendering method based on NSIWR, which was successfully applied for hemifacial spasm. The method enhances accuracy in identifying responsible blood vessels in the REZ without needing multi-modal techniques. It has the potential to improve surgical effectiveness and reduce exploration time in treating hemifacial spasm.
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Affiliation(s)
- Li Zhenzhu
- Radiology Department, Ningbo NO.2 Hospital, Ningbo, China
- Department of Neurosurgery, Ningbo NO.2 Hospital, Ningbo, China
- Faculty of Electrical Engineering and Computer Science, Ningbo University, Ningbo, China
| | - Zhang Jingfeng
- Radiology Department, Ningbo NO.2 Hospital, Ningbo, China
| | - Zhou Wei
- Department of Neurosurgery, Ningbo NO.2 Hospital, Ningbo, China
| | - Zheng Jianjun
- Radiology Department, Ningbo NO.2 Hospital, Ningbo, China
| | - Xia Yinshui
- Faculty of Electrical Engineering and Computer Science, Ningbo University, Ningbo, China
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11
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Nunta-Aree S, Kateyoi T, Sitthinamsuwan B. Delayed complete remission of hemifacial spasms following microvascular decompression and the implications for optimal time of revision surgery. Acta Neurochir (Wien) 2024; 166:12. [PMID: 38227077 DOI: 10.1007/s00701-024-05891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Microvascular decompression (MVD) is an effective method for directly treating hemifacial spasms (HFS). The timing for the consideration of failed MVD and reoperation has been paradoxical. OBJECTIVE This study aimed to investigate the delayed complete remission of HFS in terms of prevalence rate, duration between surgery and delayed complete remission, and predictive factors. METHODS A hundred patients with HFS who underwent MVD from 2012-2021 were enrolled in the study. All HFS occurred as a result of compression of the facial nerve by adjacent blood vessels. Clinical information, intraoperative findings, and surgical outcomes were incorporated for data analysis. RESULTS In the first week after MVD, 67 of 100 patients achieved complete remission of HFS, while the remaining 33 had incomplete remission. In long-term follow-up, 26 individuals gradually developed delayed complete remission with a median duration of 9.1 months. Finally, 86 of 100 patients achieved complete long-term remission. Recurrent HFS and incomplete remission were found in 7 and 7 patients, respectively. Factors associated with postoperative complete remission in the first week were a severe degree of facial nerve compression (p = 0.047, OR 2.75, 95% CI 1.01-7.40), with long-term complete remission was left-sided HFS (p = 0.012, OR 5.73, 95% CI 1.47-22.36), and with the appearance of delayed complete remission was the prolonged duration of HFS at least 3 years before MVD (p = 0.046, OR 3.75, 95% CI 1.03-13.76). Transient facial paresis was found in 11% of the patients. Of them, facial nerve function recovered completely in all cases. CONCLUSIONS A delayed complete remission of HFS could be expected in long-term follow-up after MVD and is probably related to a longer duration of HFS before surgery. Unnecessary reoperation should be avoided in the early years following the first surgery.
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Affiliation(s)
- Sarun Nunta-Aree
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Thanthip Kateyoi
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
- Department of Surgery, Prajuabkirikhan Hospital, Prajuabkirikhan, Thailand
| | - Bunpot Sitthinamsuwan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand.
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12
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Inoue T, Goto Y, Inoue Y, Adidharma P, Prasetya M, Fukushima T. Potential reasons for failure and recurrence in microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 2023; 165:3845-3852. [PMID: 38012393 DOI: 10.1007/s00701-023-05861-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/22/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND To examine the factors contributing to persistent and recurrent hemifacial spasms (HFS) following a microvascular decompression (MVD) procedure and to suggest technical improvements to prevent such failures. METHODS A retrospective review was conducted on fifty-two cases of repeat surgery. The extent of the previous craniotomy and the location of neurovascular compression (NVC) were investigated. The operative findings were categorized into two groups: "Missing Compression" and "Teflon Contact". The analysis included long-term outcomes and operative complications after repeat MVD procedures. RESULTS Missing compression was identified in 29 patients (56%), while Teflon contact was observed in 23 patients (44%). Patients with missing compression were more likely to experience improper craniotomy (66%) compared to those with Teflon contact (48%). Medially located NVC was a frequent finding in both groups, mainly due to compression by the anterior inferior cerebellar artery. In the missing compression group, during the repeat MVD, Teflon sling retraction was utilized in 79% of cases, while in the Teflon contact group, the most common procedure involved removing the Teflon in contact (65%). After the repeat MVD procedure, immediate spasm relief was achieved in 42 patients (81%), with six (12%) experiencing delayed relief. After a median follow-up of 54 months, 96% of patients were free from spasms. Delayed facial palsy, facial weakness, and hearing impairment were more frequently observed in the Teflon contact group. CONCLUSIONS A proper craniotomy that provides adequate exposure around the REZ is crucial to prevent missing the culprit vessel during the initial MVD procedure. Teflon contact on the REZ should be avoided, as it poses a potential risk of procedure failure and recurrence.
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Affiliation(s)
- Takuro Inoue
- Department of Neurosurgery, Koto Memorial Hospital, Higashiomi, Shiga, Japan.
- Department of Neurosurgery, National Brain Center Hospital, Jakarta, Indonesia.
| | - Yukihiro Goto
- Department of Neurosurgery, Koto Memorial Hospital, Higashiomi, Shiga, Japan
| | - Yasuaki Inoue
- Department of Neurosurgery, Nadogaya Hospital, Chiba, Japan
| | - Peter Adidharma
- Department of Neurosurgery, National Brain Center Hospital, Jakarta, Indonesia
| | - Mustaqim Prasetya
- Department of Neurosurgery, National Brain Center Hospital, Jakarta, Indonesia
| | - Takanori Fukushima
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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Mori K, Otani N, Toyooka T, Morita S, Numazawa S, Wada K, Watanabe S. Validation of Efficacy and Safety of TachoSil ® Tissue Sealant for Vessel Transposition in Microvascular Decompression. Oper Neurosurg (Hagerstown) 2023; 25:417-425. [PMID: 37820076 DOI: 10.1227/ons.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Use of TachoSil ® as the transposition material of microvascular decompression (MVD) for hemifacial spasm (HFS) and trigeminal neuralgia (TN) is easy and safe to perform, but the efficacy and safety of this technique are unknown. This study attempted to validate the efficacy and safety of TachoSil ® as a transposition material of MVD. METHODS A retrospective study of the surgical results and complications of 63 patients (35 HFS and 28 TN) treated by the TachoSil ® technique between January 2011 and December 2021 was conducted. The efficacy of the treatment was evaluated by Kaplan-Meier survival analysis. Magnetic resonance imaging follow-up study was performed to detect any adverse events including a mass formation. RESULTS The rate of complete disappearance of HFS was 91.4% at 1 year and estimated to be 85.7% after a 10-year follow-up. The rate of no pain without medication for TN was 85.4% at 1 year and estimated to be 69.0% after a 9-year follow-up. These surgical results are comparable with those previously reported. Flaking of TachoSil ® releasing the offending artery was only recognized in one case (1.6%). Therefore, TachoSil ® can be considered as an effective transposition material for MVD. TachoSil ® did not increase the rate of acute and subacute adverse events such as inflammation and delayed facial palsy. Magnetic resonance imaging follow-up identified no abnormalities including mass that suggested granuloma formation. CONCLUSION The efficacy of the TachoSil ® technique for HFS and TN and the reliability of TachoSil ® as an adhesive material in MVD were verified. No adverse events associated with TachoSil ® use in MVD were found. We conclude that the TachoSil ® technique has relatively long efficacy and safety for MVD.
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Affiliation(s)
- Kentaro Mori
- Department of Neurosurgery, Tokyo General Hospital, Tokyo , Japan
- Department of Neurosurgery, National Defense Medical College, Tokorozawa , Saitama , Japan
| | - Naoki Otani
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo , Japan
| | - Terushige Toyooka
- Department of Neurosurgery, National Defense Medical College, Tokorozawa , Saitama , Japan
| | - Shuhei Morita
- Department of Neurosurgery, Tokyo General Hospital, Tokyo , Japan
| | | | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College, Tokorozawa , Saitama , Japan
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Alkhayri A, Bourdillon P, Chauvet D, Bugdadi A, Alyousef M, Alsalmi S, Apra C, Lefaucheur JP, Aldea S, Le Guérinel C. Surgical treatment of hemifacial spasms: how to predict failure and complications through a series of 200 patients. Neurochirurgie 2023; 69:101498. [PMID: 37741362 DOI: 10.1016/j.neuchi.2023.101498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/16/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023]
Abstract
Primary hemifacial spasm (pHFS) is a benign but disabling movement disorder caused by a neurovascular conflict involving the facial nerve. Surgical treatment by microvascular decompression (MVD) is the most effective therapeutic. Predictors of surgical failure and surgical complications are still lacking. The aim of this study is to identify such predictors through the retrospective analysis of a series of 200 consecutive patients. All patients who underwent MVD for pHFS from January 1991 to December 2017 were included. All patients had at least two years follow-up. In addition to the demographic data, the outcome and the complications were collected. The primary outcome analysis showed that 7.5% of patients had a recurrence. Multiple and AICA related neurovascular conflicts were statistically associated to a higher recurrence rate after MVD (respectively p < 0.001 and p = 0.02). Permanent facial palsy occurred in 2.5% of patients, hearing loss in 9.0% (2.0% of complete unilateral impairment) and dizziness in 2.5%. The risk of each of these peripheral neurological impairments was statistically increased by a long duration between the first pHFS symptom and the MVD (p < 0.001). In case of recurrence, a second MDV was offered. Long term follow-up showed that all patients had a complete resolution of the HFS. Post-operative complication rate was not significantly increased after a second MVD. Multiple and AICA related neurovascular conflicts are associated to a higher risk of surgical failure. When a pHFS recurrence occurs, a second surgical procedure is associated with excellent outcome without significant increase of post-operative complications and should therefore be recommended.
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Affiliation(s)
- Abdu Alkhayri
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France; Paris Cité University, Faculty of Medicine, Paris, France
| | - Pierre Bourdillon
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France; Paris Cité University, Faculty of Medicine, Paris, France.
| | - Dorian Chauvet
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Abdulgadir Bugdadi
- Department of Surgery, Faculty of Medicine, Umm Al Qura University, Makkah, Almukarramah, Saudi Arabia
| | - Mohammed Alyousef
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sultan Alsalmi
- Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Caroline Apra
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France; Sorbonne University, Faculty of Medicine, Paris, France
| | - Jean-Pascal Lefaucheur
- Department of Neuro-physiology, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France; University of Paris-Est, Paris, France
| | - Sorin Aldea
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
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15
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Lee HS, Park K. Penetrating Offenders in Hemifacial Spasm: Surgical Tactics and Prognosis. Life (Basel) 2023; 13:2021. [PMID: 37895403 PMCID: PMC10608199 DOI: 10.3390/life13102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/22/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: In cases of hemifacial spasm (HFS), there are various patterns related to the vascular compression of the facial nerve, including a very rare form that is seen when the offending vessel penetrates the facial nerve. However, there have been few reports in the literature regarding the associated surgical techniques and postoperative prognosis. (2) Methods: A retrospective review was conducted of 4755 patients who underwent microvascular decompression (MVD) surgery from April 1997 to June 2023. In total, 8 out of the 4755 patients (0.2%) exhibited a penetrating offending vessel; the medical and surgical records of these 8 patients were then analyzed. Surgery was then attempted to maximally decompress the penetrating offender. (3) Results: Seven out of the eight patients (87.5%) were spasm-free immediately after surgery, and one had only 10% residual spasm compared to their preoperative condition. That patient was also spasm-free one year later. Postoperative facial palsy occurred in one patient (12.5%) who was assessed as grade II in the House-Brackmann grading system. In another patient, the resection of a small facial nerve bundle did not result in facial palsy. There were no cases of hearing loss or other complications. (4) Conclusions: Decompressing the penetrating offender did not increase the incidence of facial palsy, and the prognosis for hemifacial spasms was good. Therefore, when a penetrating pattern was encountered during MVD surgery, decompression between the penetrating offender and the facial nerve may offer good results.
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Affiliation(s)
- Hyun-Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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Ghaffari-Rafi A, Choi SY, Leon-Rojas J, Shahlaie K. Predictors of Multi-Vessel Identification, Outcome, and Optimal Surgical Timing for Microvascular Decompression in Hemifacial Spasm. Clin Neurol Neurosurg 2023; 233:107841. [PMID: 37544024 DOI: 10.1016/j.clineuro.2023.107841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES AND BACKGROUND Hemifacial spasm (HFS) is a disabling condition that imposes significant burden upon patients. Microvascular decompression (MVD) surgery is the most effective and long-lasting treatment for HFS, but outcomes following this surgery may vary based on a variety of clinical and operative factors. A more thorough understanding of the variables that impact patient outcome after MVD surgery is needed. METHODS A systematic review and meta-analysis of Medline, Embase, and Central was conducted (n = 2108 screened; n = 86 included) with the goal of determining the impact of the following variables on outcome: duration of disease, geographic location, intraoperative use of an endoscope, and intraoperative finding of single versus multi-vessel neurovascular compression. RESULTS Most cases of hemifacial spasm occur on the left side (53.9%, p < 0.001) and are more common in women than men (66.5% versus 33.5%, p < 0.0001). The offending vessel frequencies were: 40.8% anterior inferior cerebellar artery [AICA], 24.9% posterior inferior cerebellar artery [PICA], 17.2% multiple vessels, and 4.7% vertebral artery [VA]. Multiple vessel combinations involved: 26.5% PICA + AICA, 24.6% PICA + VA, 23.1% AICA + VA, and 4.7% AICA + PICA + VA. Relative to the Americas, AICA was less frequent in Europe (p = 0.005), while PICA more frequent in Europe (p = 0.009) and Asia (p < 0.0001). With endoscope assistance, frequency of multiple vessels identified was 31.7% (versus 14.7% with non-endoscopic, p = 0.005), and 27.4% for AICA (43.5% with non-endoscopic, p = 0.003). Spasm improvement was 94.1% near discharge and 96.0% at maximum follow-up. Complications occurred in 16.5% of cases, with spasm recurrence in 2.4%. Greatest frequency of spasm improvement (p < 0.0001) and lowest spasm recurrence rates (p = 0.0005) were reported in series from Asia. For every additional month of pre-operative spasm, the effect size of post-operative improvement decreased (p = 0.04). With every subsequent postoperative month, the effect size of spasm improvement increased (p = 0.0497). The frequency of spasm improvement was significantly higher in series published after 2005 (94.4% versus 97.4%, p = 0.005). CONCLUSION Clinical outcomes following MVD for HFS have improved since 2005. Consideration should be given to earlier operation (shorter disease duration) and use of an endoscope may increase detection of multiple offending vessels. Further studies are needed to understand regional differences in culprit vessel incidence and surgical outcomes in the Americas, Europe, and Asia.
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Affiliation(s)
- Arash Ghaffari-Rafi
- University of California, Davis, School of Medicine, Department of Neurological Surgery, Sacramento, CA, USA; University of Hawai'i at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA.
| | - So Yung Choi
- University of Hawai'i at Mānoa, John A. Burns School of Medicine, Department of Quantitative Health Sciences, Biostatistics Core Facility, Honolulu, HI, USA
| | - Jose Leon-Rojas
- Universidad de las Americas, Escuela de Medicina, Quito, Ecuador; University College London, Queen Square Institute of Neurology, London, England, UK
| | - Kiarash Shahlaie
- University of California, Davis, School of Medicine, Department of Neurological Surgery, Sacramento, CA, USA.
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Rubio AS, Rodríguez-Rubio HA, López-Rodríguez R, Bonilla-Suastegui A, Piñón-Jiménez F, Contreras-Vázquez OR, Revuelta-Gutiérrez R. Microvascular decompression for hemifacial spasm: Complications after 292 procedures without neurophysiological monitoring. Surg Neurol Int 2023; 14:343. [PMID: 37810311 PMCID: PMC10559543 DOI: 10.25259/sni_578_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Background Hemifacial spasm (HFS) is characterized by involuntary, progressive, and intermittent spasms in the upper and lower facial muscles. Due to the high success rate, microvascular decompression (MVD) is the treatment of choice, and intraoperative neuromonitoring (INM) is considered useful for achieving safe surgery. Still, most centers do not have this technology. Methods We analyzed 294 patients with HFS treated with MVD without INM. We only included patients with a neurovascular etiology while excluding other causes, such as tumors. As part of the postoperative evaluation, we assessed preoperative magnetic resonance imaging and pure-tone audiometry. Results The main complication was peripheral facial paralysis in 50 patients, followed by hypoacusis in 22 patients and deafness in 17 patients, associated with a failed surgical outcome (P = 0.0002). The anterior inferior cerebellar artery (AICA) was an offending vessel, and the involvement of more than one vessel was significantly associated with the development of facial nerve palsy (P = 0.01). AICA was also associated with hearing impairment (P = 0.04). Over 90% of immediate complications improve in the follow-up (6 months), and one patient did not show a cure for initial HFS. Conclusion MVD is the method with the highest long-term cure rates for treating HFS; however, we must inquire into the multiple factors of the patient and the surgeon to predict surgical outcomes. INM is not a must during MVD for HFS. We recommend its use depending on the availability and mainly on the surgeon's skills, for surgeons.
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Affiliation(s)
| | | | | | | | | | | | - R. Revuelta-Gutiérrez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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18
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Lenka A, Jankovic J. Peripherally-induced Movement Disorders: An Update. Tremor Other Hyperkinet Mov (N Y) 2023; 13:8. [PMID: 37008994 PMCID: PMC10064913 DOI: 10.5334/tohm.758] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Background Peripherally-induced movement disorders (PIMD) should be considered when involuntary or abnormal movements emerge shortly after an injury to a body part. A close topographic and temporal association between peripheral injury and onset of the movement disorders is crucial to diagnosing PIMD. PIMD is under-recognized and often misdiagnosed as functional movement disorder, although both may co-exist. Given the considerable diagnostic, therapeutic, and psychosocial-legal challenges associated with PIMD, it is crucial to update the clinical and scientific information about this important movement disorder. Methods A comprehensive PubMed search through a broad range of keywords and combinations was performed in February 2023 to identify relevant articles for this narrative review. Results The spectrum of the phenomenology of PIMD is broad and it encompasses both hyperkinetic and hypokinetic movements. Hemifacial spasm is probably the most common PIMD. Others include dystonia, tremor, parkinsonism, myoclonus, painful leg moving toe syndrome, tics, polyminimyoclonus, and amputation stump dyskinesia. We also highlight conditions such as neuropathic tremor, pseudoathetosis, and MYBPC1-associated myogenic tremor as examples of PIMD. Discussion There is considerable heterogeneity among PIMD in terms of severity and nature of injury, natural course, association with pain, and response to treatment. As some patients may have co-existing functional movement disorder, neurologists should be able to differentiate the two disorders. While the exact pathophysiology remains elusive, aberrant central sensitization after peripheral stimuli and maladaptive plasticity in the sensorimotor cortex, on a background of genetic (two-hit hypothesis) or other predisposition, seem to play a role in the pathogenesis of PIMD.
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Hatipoglu Majernik G, Wolff Fernandes F, Al-Afif S, Heissler HE, Palmaers T, Atallah O, Scheinichen D, Krauss JK. Routine postoperative admission to the neurocritical intensive care unit after microvascular decompression: necessary or can it be abandoned? Neurosurg Rev 2022; 46:12. [PMID: 36482263 PMCID: PMC9732061 DOI: 10.1007/s10143-022-01910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
Postoperative neurocritical intensive care unit (NICU) admission of patients who underwent craniotomy for close observation is common practice. In this study, we performed a comparative analysis to determine if there is a real need for NICU admission after microvascular decompression (MVD) for cranial nerve disorders or whether it may be abandoned. The present study evaluates a consecutive series of 236 MVD surgeries performed for treatment of trigeminal neuralgia (213), hemifacial spasm (17), vagoglossopharyngeal neuralgia (2), paroxysmal vertigo (2), and pulsatile tinnitus (2). All patients were operated by the senior surgeon according to a standard protocol over a period of 12 years. Patients were admitted routinely to NICU during the first phase of the study (phase I), while in the second phase (phase II), only patients with specific indications would go to NICU. While 105 patients (44%) were admitted to NICU postoperatively (phase I), 131 patients (56%) returned to the ward after a short stay in a postanaesthesia care unit (PACU) (phase II). Specific indications for NICU admission in phase I were pneumothorax secondary to central venous catheter insertion (4 patients), AV block during surgery, low blood oxygen levels after extubation, and postoperative dysphagia and dysphonia (1 patient, respectively). There were no significant differences in the distribution of ASA scores or the presence of cardiac and pulmonary comorbidities like congestive heart failure, arterial hypertension, or chronic obstructive pulmonary disease between groups. There were no secondary referrals from PACU to NICU. Our study shows that routine admission of patients after eventless MVD to NICU does not provide additional value. NICU admission can be restricted to patients with specific indications. When MVD surgery is performed in experienced hands according to a standard anaesthesia protocol, clinical observation on a neurosurgical ward is sufficient to monitor the postoperative course. Such a policy results in substantial savings of costs and human resources.
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Affiliation(s)
- Gökce Hatipoglu Majernik
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Filipe Wolff Fernandes
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Thomas Palmaers
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Dirk Scheinichen
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Inoue T, Goto Y, Shitara S, Keswani R, Prasetya M, Arham A, Kikuta K, Radcliffe L, Friedman AH, Fukushima T. Indication for a skull base approach in microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 2022; 164:3235-3246. [PMID: 36289112 DOI: 10.1007/s00701-022-05397-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/26/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND A thorough observation of the root exit zone (REZ) and secure transposition of the offending arteries is crucial for a successful microvascular decompression (MVD) for hemifacial spasm (HFS). Decompression procedures are not always feasible in a narrow operative field through a retrosigmoid approach. In such instances, extending the craniectomy laterally is useful in accomplishing the procedure safely. This study aims to introduce the benefits of a skull base approach in MVD for HFS. METHODS The skull base approach was performed in twenty-eight patients among 335 consecutive MVDs for HFS. The site of the neurovascular compression (NVC), the size of the flocculus, and the location of the sigmoid sinus are measured factors in the imaging studies. The indication for a skull base approach is evaluated and verified retrospectively in comparison with the conventional retrosigmoid approach. Operative outcomes and long-term results were analyzed retrospectively. RESULTS The extended retrosigmoid approach was used for 27 patients and the retrolabyrinthine presigmoid approach was used in one patient. The measurement value including the site of NVC, the size of the flocculus, and the location of the sigmoid sinus represents well the indication of the skull base approach, which is significantly different from the conventional retrosigmoid approach. The skull base approach is useful for patients with medially located NVC, a large flocculus, or repeat MVD cases. The long-term result demonstrated favorable outcomes in patients with the skull base approach applied. CONCLUSIONS Preoperative evaluation for lateral expansion of the craniectomy contributes to a safe and secure MVD.
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Affiliation(s)
- Takuro Inoue
- Department of Neurosurgery, Subarukai Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, 527-0134, Shiga, Japan. .,Department of Neurosurgery, Indonesia National Brain Center Hospital, East Jakarta, Special Capital Region of Jakarta, Indonesia.
| | - Yukihiro Goto
- Department of Neurosurgery, Subarukai Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, 527-0134, Shiga, Japan
| | - Satoshi Shitara
- Department of Neurosurgery, Subarukai Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, 527-0134, Shiga, Japan
| | - Ryan Keswani
- Department of Neurosurgery, Indonesia National Brain Center Hospital, East Jakarta, Special Capital Region of Jakarta, Indonesia
| | - Mustaqim Prasetya
- Department of Neurosurgery, Indonesia National Brain Center Hospital, East Jakarta, Special Capital Region of Jakarta, Indonesia
| | - Abrar Arham
- Department of Neurosurgery, Indonesia National Brain Center Hospital, East Jakarta, Special Capital Region of Jakarta, Indonesia
| | - Kenichiro Kikuta
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | | | - Allan H Friedman
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Takanori Fukushima
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Goto Y, Inoue T. Common trunk anomaly of the anterior and posterior inferior cerebellar artery in hemifacial spasm. Acta Neurochir (Wien) 2022; 164:2945-2951. [PMID: 35524812 DOI: 10.1007/s00701-022-05230-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The common trunk anomaly of the anterior and posterior inferior cerebellar artery (APC) is a variant artery that causes a hemifacial spasm (HFS). The anatomical characteristics include a large diameter of the trunk and the existence of the bifurcation near the facial nerve root entry zone (REZ). Despite APC being encountered at a constant rate in microvascular decompression (MVD), the anatomical and technical issues of transposing APC have not been entirely focused on yet. METHODS We reviewed our 68 cases with APC involvement. Patient background, radiological findings, and operative video recordings were reviewed retrospectively. The location of the bifurcation of APC and the distribution of perforators were investigated. Surgical outcomes were assessed in the long term. RESULTS APC involvement was diagnosed preoperatively in all cases by careful observation with MRI. Three-dimensional images determined the anatomical characteristics of APC and depicted the relationship with the facial nerve. All patients had a bifurcation close to the root entry zone that was required to transpose, including the common trunk and the distal branches, to achieve sufficient decompression. While adequate transposition from the REZ was accomplished in most cases, it was difficult to complete transposition due to short perforators in 6 patients (8.8%), resulting in interposition. Fifty-three patients (77.9%) became spasm free immediately after surgery, 66 patients (97.1%) were after 6 months, and all patients (100%) became spasm free within a year. Spasm-free status was maintained during the follow-up period (4.7 years) in all patients except one in whom facial spasm recurred 2 years after the initial surgery. CONCLUSIONS Transposing the common trunk with the bifurcation and distal branches contributes to obtaining favorable surgical outcomes in APC-related HFS.
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Affiliation(s)
- Yukihiro Goto
- Department of Neurosurgery, Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan.
| | - Takuro Inoue
- Department of Neurosurgery, Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan
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22
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Reoperation for residual or recurrent hemifacial spasm after microvascular decompression. Acta Neurochir (Wien) 2022; 164:2963-2973. [PMID: 35922722 DOI: 10.1007/s00701-022-05315-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/10/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE Microvascular decompression (MVD) surgery is the only potential curative method for hemifacial spasm (HFS). Little attention is paid to those recurrent/residual HFS cases. We want to study the potential etiology of those recurrent/residual HFS cases and evaluate the value of reoperation. METHODS We retrospectively reviewed reoperation hemifacial spasm patients in our hospital. Intraoperative videos or images were carefully reviewed, and the etiology of recurrent/residual HFS is roughly divided into three categories. Intraoperative findings, surgical outcomes, and complications were carefully studied to assess the value of reoperation for recurrent/residual HFS patients. RESULTS A total of 28 cases were included in our case series. Twenty-three of them are recurrent HFS cases, and 5 of them are residual HFS cases. The mean follow-up duration is 24.96 months. There are seventeen patients with missed culprit vessels or insufficient decompression of root exit zone (REZ), eight patients with Teflon adhesion, and three patients with improper application of decompression materials in our case series. The final reoperation outcome with 17 excellent, seven good, and four fair, respectively. Eight (28.57%) of them experienced long-term complications after reoperation. CONCLUSION Re-operation for recurrent/residual HFS is an effective therapy and can achieve a higher cure rate. However, the complication rate is higher compared to the first MVD surgery. Accurately identifying REZ and proper decompression strategies to deal with the culprit vessels are very important for surgical success. TRIAL REGISTRATION NUMBER UIN: researchregistry7603. Date of registration: Jan. 31st, 2022 "retrospectively registered".
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23
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Cai X, Tang Y, Zhao H, Chen Z, Wang H, Zhu W, Li S. A Case Report of Hemifacial Spasm Caused by Vestibular Schwannoma and Literature Review. Brain Sci 2022; 12:1347. [PMID: 36291281 PMCID: PMC9599054 DOI: 10.3390/brainsci12101347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Most cases of hemifacial spasm result from mechanical compression at the root exit zone of the facial nerve by vascular loops, and only a few cases are caused by vestibular schwannoma. CASE PRESENTATION We report a case of symptomatic hemifacial spasm induced by a small vestibular schwannoma that was totally resected. A 64-year-old man was admitted to our department with a 14-month history of symptomatic right-sided hemifacial spasm. During the process of microvascular decompression, no definite vessel was found to compress the facial nerve. By further exploration of regions other than root exit zone, a small vestibular schwannoma compressing the internal auditory canal portion of facial nerve from the ventral side was discovered. Resection of the tumor was then conducted. The symptoms of hemifacial spasm disappeared immediately after surgery. CONCLUSIONS We should be aware that magnetic resonance imaging is not always precise and perhaps misses some miniature lesions due to present image technique limitations. A small vestibular schwannoma might be the reason for HFS, although preoperative magnetic resonance tomography angiography showed possible vascular compression at the facial nerve root. More importantly, a full-length exploration of the facial nerve is in urgent need to find potential compression while performing microvascular decompression for HFS patients.
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Affiliation(s)
| | | | | | | | | | | | - Shiting Li
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, The Cranial Nerve Disease Center of Shanghai Jiaotong University, Shanghai 200092, China
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24
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Patel KP, Eubanks K, Wecht DA, Sekula RF. Facial Nerve Massage for the Treatment of Hemifacial Spasm Refractory to Microvascular Decompression: Outcomes and Complications. Neurosurgery 2022; 91:570-574. [PMID: 35876666 DOI: 10.1227/neu.0000000000002075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND After microvascular decompression (MVD) for hemifacial spasm (HFS), a minority of patients realize little to no relief of spasms. In some patients, the absence of relief of spasms results from incomplete or inadequate decompression of vascular compression of the facial nerve, and these patients represent excellent candidates for repeat MVD. However, in other patients, repeat MVD is not appropriate because adequate decompression and resolution of neurovascular compression, as determined by postoperative high-resolution MRI, was achieved with the initial operation. OBJECTIVE To present a cohort of patients with a history of HFS refractory to MVD, with no evidence of neurovascular compression on postoperative MRI, who underwent facial nerve massage (FNM) in the posterior fossa in an attempt to relieve spasms. METHODS Thirteen patients with a history of incomplete relief of spasms after technically adequate MVD surgery for hemifacial spasm underwent FNM. Immediate and long-term degree of spasm relief and complications after FNM were documented through in-person or telemedicine interview. RESULTS At follow-up after FNM, 7 of 12 patients (58.3%) reported complete spasm relief (grade I), 2 of 12 patients (16.7%) reported >75% spasm relief (grade II), 0 patient (0%) reported >50% spasm relief (grade III), 3 of 12 (25.0%) patients reported <50% spasm relief (grade IV), and 1 patient was lost to follow-up. One patient experienced a delayed facial paresis, and another patient experienced high-frequency hearing loss. CONCLUSION After FNM, durable and, at least, partial relief of spasms with a relatively low complication rate was observed in most patients with HFS with incomplete relief of spasms after technically adequate prior MVD.
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Affiliation(s)
- Kevin P Patel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Komal Eubanks
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel A Wecht
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raymond F Sekula
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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25
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Lee JA, Kong DS, Lee S, Park SK, Park K. Chronological Patterns of Long-Term Outcomes After Microvascular Decompression for Hemifacial Spasm Over 5 Years. World Neurosurg 2022; 166:e313-e318. [PMID: 35817354 DOI: 10.1016/j.wneu.2022.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The postoperative course of hemifacial spasm (HFS) varies. We analyzed the clinical outcomes from 1 to ≥5 years after microvascular decompression (MVD) in patients with HFS. METHODS Between July 2004 and January 2015, 528 patients who were followed up for ≥5 years after MVD for HFS were included. We evaluated chronological patterns of clinical outcomes from 1 to ≥5 years. The outcomes at 2, 3, 4, and ≥5 years postoperatively were individually compared with those at 1 year postoperatively, and the relationships between clinical features, surgical findings, and outcomes over time were analyzed. RESULTS Eight groups were created according to the similarity in the pattern of clinical outcomes from 1 to ≥5 years postoperatively. Individual postoperative outcomes at 2-4 years were consistent with those at 1 year postoperatively, whereas postoperative outcomes at ≥5 years were not (P = 0.020). There was substantial to moderate agreement between the outcomes at 1 year and at 2-4 years postoperatively, but the agreement decreased over time. Patients without diabetes (P = 0.015), an intraoperative offending vessel without a vein (P = 0.005), and intraoperative discoloration of the facial nerve (P = 0.036) showed better outcomes at ≥5 years postoperatively. CONCLUSIONS Long-term outcomes from 1 to ≥5 years after MVD in patients with HFS were diverse. Nondiabetes, intraoperative offending vessel without a vein, and intraoperative discoloration of the facial nerve were better prognostic factors for outcomes at ≥5 years postoperatively. It is advisable to consider these results when evaluating the long-term outcomes of this surgery.
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Affiliation(s)
- Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea.
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26
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Komatsu F, Sasaki K, Tanaka R, Miyatani K, Yamada Y, Kato Y, Hirose Y. Coexistence of neurovascular compression syndrome and unruptured cerebral aneurysm. J Clin Neurosci 2022; 105:22-25. [PMID: 36057158 DOI: 10.1016/j.jocn.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022]
Abstract
Unruptured cerebral aneurysms (UCAs) are usually asymptomatic and detected incidentally by intracranial examinations. The coexistence of neurovascular compression syndrome (NVCS) and UCAs has not been well described. The aim of this study was to clarify the characteristics of UCAs with the NVCS. A total of 103 cases that underwent microvascular decompression (MVD) for trigeminal neuralgia (TN) or hemifacial spasm (HFS) were assigned to the NVCS group. The prevalence of UCAs in the NVCS group was compared retrospectively to that in 110 control cases (a control group) by neuro-imaging. Overall treatment courses for NVCS and UCAs were investigated in the NVCS group. Sixteen (15.3%; TN 11 cases, HFS 5 cases) of 103 MVD cases had 19 UCAs, a significantly higher prevalence than the 3.6% in the control group. Binomial logistic regression showed that NVCS is a significant factor for predicting the presence of UCAs, with an odds ratio of 4.80. In the NVCS group, 18 UCAs (94.7%) were supratentorial aneurysms, and 17 UCAs (89.5%) were less than 5 mm in size. Nine UCAs were surgically treated with clipping or coiling. Of the surgical cases, 2 UCAs were treated before MVD for NVCS, whereas the other 7 UCAs were treated after MVD. No aneurysms ruptured during the treatment course. The NVCS occurred with UCAs at a significantly higher rate than in the control group. Most UCAs with the NVCS were supratentorial, small aneurysms that did not affect the surgical treatment of NVCS.
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Affiliation(s)
- Fuminari Komatsu
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan.
| | - Kento Sasaki
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan
| | - Riki Tanaka
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan
| | - Kyosuke Miyatani
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health Unversity Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ward, Nagoya, Aichi 454-8509, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, 1-98 Kutsukakechodengakugakubo, Toyoake, Aichi 470-1192, Japan
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Safety and efficacy of clonazepam in patients with hemifacial spasm: A double-blind, randomized, placebo-controlled trial. Parkinsonism Relat Disord 2022; 103:1-6. [DOI: 10.1016/j.parkreldis.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/21/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022]
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Nagahiro S, Mizobuchi Y, Nakajima K, Takagi Y. A Novel Approach to Microvascular Decompression for Hemifacial Spasm: Method Description and Associated Outcomes. Oper Neurosurg (Hagerstown) 2022; 23:e16-e22. [PMID: 35486878 DOI: 10.1227/ons.0000000000000223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/27/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Microvascular decompression (MVD) is the only potential cure for hemifacial spasm (HFS). However, traditional techniques such as the interposition method may have limited effect in some cases. Alternative techniques have been proposed; however, they can be more complex or difficult to perform than the standard approach. OBJECTIVE To describe a safe decompression technique-the "shelter method"-which involves creating a shelter-like space around the facial nerve root exit zone and present associated outcomes. METHODS Medical records and intraoperative findings of 92 patients with HFS who underwent MVD using the shelter method between April 1997 and March 2017 were retrospectively reviewed. As a historical control group, we included 53 patients who had undergone MVD by the traditional interposition method before March 1989. The patients were divided into 3 subgroups according to the arteries involved and degree or direction of arterial compression to the seventh nerve. Patient outcomes were assessed as excellent, good, fair, and poor according to the MVD scoring system of the Japan Society for MVD Surgery. RESULTS In the shelter method group, complete disappearance of HFS was achieved in 87 patients (94.6%). The curative rate of the shelter method group was significantly higher than that of the interposition method group. The overall complication rates were significantly lower in the shelter method group than in the interposition method group. CONCLUSION Our findings indicate high curative and low complication rates of the shelter method, suggesting that it helps treat HFS caused by various types of arterial compression.
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Affiliation(s)
- Shinji Nagahiro
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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29
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Bai R, Liu X, Jiang S, Sun H. Deep Learning Based Real-Time Semantic Segmentation of Cerebral Vessels and Cranial Nerves in Microvascular Decompression Scenes. Cells 2022; 11:1830. [PMID: 35681525 PMCID: PMC9180010 DOI: 10.3390/cells11111830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 12/03/2022] Open
Abstract
Automatic extraction of cerebral vessels and cranial nerves has important clinical value in the treatment of trigeminal neuralgia (TGN) and hemifacial spasm (HFS). However, because of the great similarity between different cerebral vessels and between different cranial nerves, it is challenging to segment cerebral vessels and cranial nerves in real time on the basis of true-color microvascular decompression (MVD) images. In this paper, we propose a lightweight, fast semantic segmentation Microvascular Decompression Network (MVDNet) for MVD scenarios which achieves a good trade-off between segmentation accuracy and speed. Specifically, we designed a Light Asymmetric Bottleneck (LAB) module in the encoder to encode context features. A Feature Fusion Module (FFM) was introduced into the decoder to effectively combine high-level semantic features and underlying spatial details. The proposed network has no pretrained model, fewer parameters, and a fast inference speed. Specifically, MVDNet achieved 76.59% mIoU on the MVD test set, has 0.72 M parameters, and has a 137 FPS speed using a single GTX 2080Ti card.
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Affiliation(s)
- Ruifeng Bai
- Changchun Institute of Optics, Fine Mechanics and Physics, Chinese Academy of Sciences, Changchun 130033, China; (R.B.); (S.J.)
- University of Chinese Academy of Sciences, Beijing 100049, China;
| | - Xinrui Liu
- University of Chinese Academy of Sciences, Beijing 100049, China;
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, China
| | - Shan Jiang
- Changchun Institute of Optics, Fine Mechanics and Physics, Chinese Academy of Sciences, Changchun 130033, China; (R.B.); (S.J.)
| | - Haijiang Sun
- Changchun Institute of Optics, Fine Mechanics and Physics, Chinese Academy of Sciences, Changchun 130033, China; (R.B.); (S.J.)
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Zhou J, Shi Q, Jiang L, Xie Y, Deng B, Zhan Y. Association study of the pneumatization degree of mastoid air cells and postoperative complications after microvascular decompression in hemifacial spasm. Acta Neurochir (Wien) 2022; 164:1543-1550. [PMID: 35190898 DOI: 10.1007/s00701-022-05155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to analyse the association between the degree of pneumatization of mastoid air cells (MACs) and postoperative complications after microvascular decompression in hemifacial spasm. METHODS We retrospectively reviewed 308 patients with hemifacial spasm who underwent surgery at our institute between January 2017 and March 2021. The degree of pneumatization of MACs was classified into four grades (grades 1, 2, 3, and 4) according to method of Han et al. The clinical data of the four grades were analysed and statistically examined. RESULTS There were no statistically significant differences between the four grades in terms of the operative time, intraoperative blood loss, and postoperative hospital stay (all, P > 0.05). The incidence of hearing loss was higher in grade 4 MACs (26.56%) than in grades 1 and 2 MACs (5.41% and 2.89%, respectively; P < 0.05). The incidence of facial paralysis was higher in grade 4 MACs (28.13%) than in grades 1 and 2 MACs (5.41% and 9.18%, respectively; P < 0.001). The incidence of intracranial infection was higher in grade 3 MACs (17.65%) than in grade 2 MACs (3.89%) (P < 0.05). All four patients with cerebrospinal fluid leakage belonged to grade 4 MACs. The incidence of cerebrospinal fluid leakage was higher in grade 4 MACs (5.13%) than in grade 2 MACs (P < 0.05). CONCLUSIONS This study found that the degree of pneumatization of MACs was closely related to the postoperative complications after MVD surgeries. Well-pneumatized MACs increase the risk of cerebrospinal fluid leakage and intracranial infection. However, insufficient exposure increases the risk of facial paralysis and hearing loss. For patients with well-pneumatized MACs, sufficient surgical exposure is the top priority when locating the bone hole. For those who may have a latent MAC opening, preventive occlusion should be considered.
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Affiliation(s)
- Jianxin Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Quanhong Shi
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Li Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yanfeng Xie
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Bo Deng
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yan Zhan
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Shafizadeh M, Maroufi SF, Ahmadi M, Khoshnevisan A. Microvascular Decompression for Hypoglossal Nerve Palsy Associated With Vertebral Artery: Case Report and Review of Literature. NEUROSURGERY OPEN 2022. [DOI: 10.1227/neuopn.0000000000000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sprenghers L, Lemmens R, van Loon J. Usefulness of intraoperative monitoring in microvascular decompression for hemifacial spasm: a systematic review and meta-analysis. Br J Neurosurg 2022; 36:346-357. [PMID: 35313771 DOI: 10.1080/02688697.2022.2049701] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To review the diagnostic accuracy and possible added value of Brainstem Auditory Evoked Potentials (BAEP) monitoring and Lateral Spread Response (LSR) monitoring in microvascular decompression surgery for hemifacial spasms. METHODS For this systematic review we followed the PRISMA guidelines. We searched different databases and bibliographies of articles. We included studies on BAEP and LSR monitoring that reported data on hearing outcome or efficacy. Selected studies were assessed for bias using the MINORS tool. RESULTS 64 articles were selected for qualitative synthesis, 42 met inclusion criteria for meta-analysis. The overall incidence of hearing loss was 3.4%. For BAEP monitoring AUC and pooled OR with 95% confidence interval were 0.911 (0.753-0.933) and 7.99 (3.85-16.60) respectively. Short-term data on LSR monitoring showed an overall spasm relief rate of 89% with pooled OR, sensitivity and specificity with a 95% confidence interval of 8.80 (4.82-16.08), 0.911 (0.863-0.943) and 0.451 (0.342-0.564) respectively. Long-term data on LSR monitoring showed an overall spasm relief rate of 95% with pooled OR, sensitivity and specificity with a 95% confidence interval of 4.06 (2.15-7.64), 0.871 (0.817-0.911) and 0.39 (0.294-0.495) respectively. CONCLUSION The alarm criteria, a wave V latency prolongation of 1ms or a wave V amplitude decrement of 50%, proposed by the 'American Clinical Neurophysiology Society' are a sensitive predictor for postoperative hearing loss. Other BAEP wave changes, for example, complete loss of wave V, are more specific but correspond to irreversible damage and are therefore not useful as warning criteria. LSR monitoring has high diagnostic accuracy at short-term follow-up. At long-term follow-up, diagnostic accuracy decreases because most patients get spasm relief regardless of their LSR status. LSR persistence after surgery has a good long-term outcome, as long as an extensive exploration of the facial nerve has been performed.
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Affiliation(s)
| | - Robin Lemmens
- Department of Neurology, University Hospital Leuven, University of Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospital Leuven and Laboratory of Experimental Neurosurgery and Neuroanatomy, University of Leuven, Leuven, Belgium
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A multivariable prediction model for recovery patterns and time course of symptoms improvement in hemifacial spasm following microvascular decompression. Acta Neurochir (Wien) 2022; 164:833-844. [PMID: 35103860 PMCID: PMC8913470 DOI: 10.1007/s00701-022-05133-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Microvascular decompression (MVD) success rates exceed 90% in hemifacial spasm (HFS). However, postoperative recovery patterns and durations are variable. OBJECTIVE We aim to study factors that might influence the postoperative patterns and duration needed until final recovery. METHOD Only patients following de-novo MVD with a minimum follow-up of 6 months were included. Overall trend of recovery was modeled. Patients were grouped according to recognizable clinical recovery patterns. Uni- and multivariable analyses were used to identify the factors affecting allocation to the identified patterns and time needed to final recovery. RESULTS A total of 323 (92.6%) patients had > 90% symptom improvement, and 269 (77.1%) patients had complete resolution at the last follow-up. The overall trend of recovery showed steep remission within the first 6 months, followed by relapse peaking around 8 months with a second remission ~ 16 months. Five main recovery patterns were identified. Pattern analysis showed that evident proximal indentation of the facial nerve at root exit zone (REZ), males and facial palsy are associated with earlier recovery at multivariable and univariable levels. anterior inferior cerebellar artery (AICA), AICA/vertebral artery compressions and shorter disease durations are related to immediate resolution of the symptoms only on the univariable level. Time analysis showed that proximal indentation (vs. distal indentation), males and facial palsy witnessed significantly earlier recoveries. CONCLUSION Our main finding is that in contrast to peripheral indentation, proximal indentation of the facial nerve at REZ is associated with earlier recovery. Postoperative facial palsy and AICA compressions are associated with earlier recoveries. We recommend a minimum of 1 year before evaluating the final outcome of MVD for HFS.
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Wang J, Chong Y, Jiang C, Dai Y, Liang W, Ding L. Microvascular decompression for hemifacial spasm involving the vertebral artery. Acta Neurochir (Wien) 2022; 164:827-832. [PMID: 34870744 PMCID: PMC8913562 DOI: 10.1007/s00701-021-05076-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022]
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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Affiliation(s)
- Jing Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Yulong Chong
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Chengrong Jiang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Yuxiang Dai
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Weibang Liang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Lianshu Ding
- Department of Neurosurgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 West Beijing Road, Huaian, 223001, Jiangsu, China.
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Wei J, Hu X, Xia L, Shang J, Han Q, Zhang D. Evaluation of the effect of botulinum toxin A on the physical and mental health of patients with hemifacial spasm. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Li J, Lyu L, Chen C, Yin S, Jiang S, Zhou P. The outcome of microvascular decompression for hemifacial spasm: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:2201-2210. [PMID: 35048261 DOI: 10.1007/s10143-022-01739-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 02/05/2023]
Abstract
Microvascular decompression (MVD) is the first choice of surgery for hemifacial spasm (HFS). MVD surgery for vertebral artery (VA)-associated HFS is more difficult than for non-VA-associated HFS. There is controversy about the cure rate and complication of MVD for HFS in previous studies. We searched PubMed, Web of Science, and Embase for relevant publications. Based on the search results, we compared the outcomes of MVD for VA-associated HFS and non-VA-associated HFS. At the same time, we analyzed spasm-free rates and the complications and assessed the relationship between VA-associated HFS and gender, left side, and age. For analysis, six studies that included 2952 patients in the VA-associated group and 604 in the non-VA-associated group were selected. The effective rate of MVD was not significantly different between both groups (OR = 1.16, 95% CI 0.81-1.67, P = 0.42). Compared to non-VA-associated group, the transient complications (OR = 0.64, 95% CI 0.46-0.89, P = 0.008) and permanent complications (OR = 0.28, 95% CI 0.15-0.54, P = 0.0001) occurred more frequently in VA-associated group. The rate of hearing loss was significantly higher in VA-associated HFS than non-VA-associated HFS (OR = 0.35, 95% CI 0.19-0.64, P = 0.0007); the facial paralysis after operation was not significantly different between both groups (OR = 1.25, 95% CI 0.91-1.72, P = 0.17). There were older patients (WMD = 3.67, 95% CI 3.29-4.05, P < 0.00001) and more left-sided HFS (OR = 0.23, 95% CI 0.19 - 0.29, P < 0.0002) in the VA-associated HFS group than non-VA-associated HFS group, while the non-VA-associated HFS group was female-dominated (OR = 1.58, 95% CI 1.32 - 1.89, P < 0.00001). Both groups achieved good results in MVD cure rates. In VA-associated HFS, the complication rate of decompression and the rate of hearing loss after operation were higher than in non-VA-associated HFS, but the facial paralysis after operation was similar in both groups, and most complications were transient and disappeared during follow-up. VA-associated HFS is more prevalent in older adults, less prevalent in women, and more predominantly left-sided. More clinical studies are needed to better compare the efficacy and complication of MVD between both groups.
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Affiliation(s)
- Jianguo Li
- Department of Neurosurgery, Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, China
| | - Liang Lyu
- Department of Neurosurgery, Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, China
| | - Cheng Chen
- Department of Neurosurgery, Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, China
| | - Senlin Yin
- Department of Neurosurgery, Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, China
| | - Shu Jiang
- Department of Neurosurgery, Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, China
| | - Peizhi Zhou
- Department of Neurosurgery, Pituitary Adenoma Multidisciplinary Center, West China Hospital of Sichuan University, Guoxue Alley, No. 37, Chengdu, 610041, China.
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Ruen L, Fang L, Haidong S, Jianfeng L. Analysing Correlation Between the Facial Nerve Notch at the Root Exit Zone and Long-term Effect in Patients with Hemifacial Spasm After Microvascular Decompression: A Prospective Study. Neurol India 2022; 70:1819-1823. [DOI: 10.4103/0028-3886.359293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Nonaka T, Sakata K, Abe T, Hattori G, Orito K, Miyagi N, Tokutomi T, Morioka M. The eagle jugular syndrome as the cause of delayed intracranial hemorrhage after microvascular decompression for hemifacial spasm: A case report. Surg Neurol Int 2021; 12:584. [PMID: 34992901 PMCID: PMC8720428 DOI: 10.25259/sni_808_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/11/2021] [Indexed: 11/04/2022] Open
Abstract
Background:
Eagle syndrome is a rare disorder whereby an elongated styloid process (ESP) causes not only some otolaryngological symptoms, but also cerebrovascular events caused by compression of the carotid artery. In recent years a syndrome, denominated as Eagle jugular syndrome, involving internal jugular vein (IJV) compression caused by an ESP has been proposed as a variation of Eagle syndrome. Clinical impact of the Eagle jugular syndrome on neurosurgical procedures has not been reported yet.
Case Description:
We present a case of a 68-year-old woman who underwent microvascular decompression for hemifacial spasm of the left side and developed delayed intracranial hemorrhage on postoperative day 3. We also demonstrate that this patient developed ipsilateral IJV stenosis between an ESP and the muscle bundle of the rectus capitis lateralis with antero-flexion neck position, which would induce venous congestion in addition to surgical disruption of emissary vein.
Conclusion:
This case is the first report demonstrating the association of an ESP with postoperative delayed intracranial hemorrhage. Our report elucidates the importance of the awareness among neurosurgeons of considering the ESP as an important bony anomaly, especially when planning for posterior fossa surgery.
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Affiliation(s)
- Takahisa Nonaka
- Department of Neurosurgery, School of Medicine, Kurume University, Kurume City, Fukuoka, Japan
| | - Kiyohiko Sakata
- Department of Neurosurgery, School of Medicine, Kurume University, Kurume City, Fukuoka, Japan
| | - Toshi Abe
- Department of Radiology, School of Medicine, Kurume University, Kurume City, Fukuoka, Japan
| | - Gohsuke Hattori
- Department of Neurosurgery, School of Medicine, Kurume University, Kurume City, Fukuoka, Japan
| | - Kimihiko Orito
- Department of Neurosurgery, School of Medicine, Kurume University, Kurume City, Fukuoka, Japan
| | - Naohisa Miyagi
- Department of Neurosurgery, School of Medicine, Kurume University, Kurume City, Fukuoka, Japan
| | - Takashi Tokutomi
- Department of Neurosurgery, School of Medicine, Kurume University, Kurume City, Fukuoka, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, School of Medicine, Kurume University, Kurume City, Fukuoka, Japan
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McGahan BG, Albonette-Felicio T, Kreatsoulas DC, Magill ST, Hardesty DA, Prevedello DM. Simultaneous Endoscopic and Microscopic Visualization in Microvascular Decompression for Hemifacial Spasm. Oper Neurosurg (Hagerstown) 2021; 21:540-548. [PMID: 34662911 DOI: 10.1093/ons/opab348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/31/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hemifacial spasm (HFS) is a socially limiting condition leading to decreased quality of life that can be treated with microvascular decompression (MVD). Endoscopy has been described as an adjunct to traditional microscopy for MVD, although the best visualization technique is debated. OBJECTIVE To review the current literature on use of endoscopy in MVD for HFS and to describe the simultaneous microscopic and endoscopic visualization technique along with a video illustration. METHODS Patients who underwent MVD for HFS were retrospectively reviewed from January 2011 to December 2019. The first set of patients in the series were done using traditional endoscopic assisted visualization, followed by a change in technique in the subsequent patients using the simultaneous endoscopic technique. The surgical technique is described as well as illustrated with a video. RESULTS In total, 21 patients underwent 24 MVDs to treat HFS. The simultaneous endoscopic/microscopic technique was used in 48% of cases for visualization. All but one patient had resolution of their symptoms immediately after the procedure. In total, 7 patients had recurrence of HFS, with 4 (17%) resolving spontaneously and 3 (13%) ultimately undergoing redo MVD. Postoperatively 7 patients (29%) had transient complications that all resolved completely. There was no significant difference between the traditional alternating microscopic and endoscopic technique with the simultaneous endoscopic microscopic technique. CONCLUSION Endoscopic assistance during MVD for HFS is beneficial and may be streamlined by using the simultaneous microscope and endoscope visualization technique.
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Affiliation(s)
- Ben G McGahan
- Department of Neurosurgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | | | - Daniel C Kreatsoulas
- Department of Neurosurgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen T Magill
- Department of Neurosurgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA.,Northwestern University, Feinberg School of Medicine, Neurological Surgery, Chicago, IL, USA
| | - Douglas A Hardesty
- Department of Neurosurgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
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Argie D, Lauren C, Malelak EB. A Rare Combined Trigeminal Neuralgia with Hemifacial Spasm in a 78-year-old Male Patient. Asian J Neurosurg 2021; 16:630-633. [PMID: 34660385 PMCID: PMC8477817 DOI: 10.4103/ajns.ajns_433_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/25/2020] [Accepted: 04/15/2021] [Indexed: 11/23/2022] Open
Abstract
This case reported a 78-year-old male patient presented with combined trigeminal neuralgia and hemifacial spasm, which is a rare finding and seldom addressed. Magnetic resonance imaging examination showed compression of right N.V by the right superior cerebellar artery (SCA) but did not prove any compression on the right N.VII. This patient is treated with microvascular decompression, and we found out compression of right N.V by right SCA and N.VII from the right anterior inferior cerebellar artery. Postoperatively, the symptoms were resolved with transient hypoesthesia and no recurrence after 1-year follow-up.
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Affiliation(s)
- Donny Argie
- Department of Neurosurgery, Prof. Dr. W.Z. Johannes Kupang Regional General Hospital, Kupang, East Nusa Tenggara, Indonesia
| | - Christopher Lauren
- Department of Neurosurgery, Prof. Dr. W.Z. Johannes Kupang Regional General Hospital, Kupang, East Nusa Tenggara, Indonesia
| | - Elric Brahm Malelak
- Department of Neurosurgery, Prof. Dr. W.Z. Johannes Kupang Regional General Hospital, Kupang, East Nusa Tenggara, Indonesia
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Liu J, Li F, Wu G, Liu B, Zhou J, Fan C, Jiao F, Wang D, Wu G, Song H, Liu R. Long-Term Retrospective Analysis of Re-do Microvascular Decompression in Patients With Hemifacial Spasm. Front Neurol 2021; 12:687945. [PMID: 34539549 PMCID: PMC8442547 DOI: 10.3389/fneur.2021.687945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: To explore the clinical characteristics of patients with persistent or recurrent hemifacial spasm (HFS) and the experience of microvascular decompression (MVD) in the treatment of such patients to accumulate additional clinical evidence for optimal treatment protocols. Methods: We retrospectively analyzed the clinical data, surgical methods and treatment efficacies of 176 patients with persistent or recurrent HFS from January 2009 to January 2018. Results: Missing compression zones was the main reason for symptom persistence (87.50%) or recurrence (71.50%) after MVD treatment of HFS. We divided the surgical area into three zones. Most persistent or recurrent cases had decompression only in the root exit zone (REZ) (Zone 1) but missed the ventrolateral pons-involved area (Zone 2) or the bulbopontine sulcus-involved area (Zone 3) in the first MVD. Too much use of Teflon (12.50%), arachnoid adhesions (5.60%) and Teflon granulomas (10.40%) can also cause a recurrence. The difference between preoperative and postoperative Cohen scores was statistically significant in persistent or recurrent HFS patients (p<0.05). The postoperative follow-up time ranged from 36 to 108 months (71.75 ± 22.77). Conclusions: MVD should be performed in the compression site, which is mostly located at the brainstem/facial REZ. Intraoperative exploration should be conducted in accordance with the abovementioned zones to effectively avoid missing offending vessels. Re-do MVD is effective in patients with persistent or recurrent HFS.
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Affiliation(s)
- Jiayu Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Fang Li
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Guangyong Wu
- Department of Neurosurgery, The Hospital of Shunyi District, Beijing, China
| | - Bo Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Jingru Zhou
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Cungang Fan
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Feng Jiao
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Dongliang Wang
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Gang Wu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Haidong Song
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Ruen Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
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Fully endoscopic versus microscopic vascular decompression for hemifacial spasm: a retrospective cohort study. Acta Neurochir (Wien) 2021; 163:2417-2423. [PMID: 33765219 DOI: 10.1007/s00701-021-04824-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Microvascular decompression (MVD) is the preferred surgical method for hemifacial spasm (HFS). The purpose of this study was to analyze the effectiveness and safety of fully endoscopic MVD for HFS relative to microscopic MVD. MATERIAL AND METHODS The retrospective study was conducted on HFS patients who underwent microscopic or fully endoscopic MVD from January 2018 to March 2019. All patients were treated at a single institution and by a single surgeon. Patients were divided into two groups based on the surgical method, and clinical data were then compared between groups. RESULTS A total of 116 patients, including 54 cases who received fully endoscopic MVD (E group) and 62 cases who received microscopic MVD (M group), were included in this study. Follow-up efficacy did not differ significantly between groups, with total effective rates of 88.9% in the E group and 90.3% in the M group. When postoperative complications were compared individually, there were no statistically significant differences between the two groups; however, the E group had a higher total incidence of complications than the M group (48.1% vs. 29.0%, P = 0.034). CONCLUSION Although both fully endoscopic and microscopic MVD for HFS achieved good efficacy, the former method had a higher total incidence of complications. Based on the results of this study, there is no evidence that a microscope can be replaced by a full endoscope in MVD for HFS.
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Wu F, Wei P, Wang G, Wu C, Hu Y, Hu J. Roles of preoperative anxiety and depression in the outcomes of microvascular decompression in hemifacial spasm for adolescent patients. Medicine (Baltimore) 2021; 100:e26831. [PMID: 34397888 PMCID: PMC8360617 DOI: 10.1097/md.0000000000026831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/16/2021] [Indexed: 01/04/2023] Open
Abstract
Hemifacial spasm (HFS) has been recognized as the frequently occurring disease of cranial nerve. At the same time, several articles indicate that, dystonia results in certain psychological disorders. Consequently, this study aimed to examine the association of preoperative depression and anxiety with HFS severity; meanwhile, the role in microvascular decompression (MVD) outcomes after surgery among adolescent patients was also examined.All cases had been classified as two groups based on MVD outcomes among HFS cases; in addition, the preoperative Hamilton anxiety rating scale (HARS) and the Hamilton depression rating scale (HDRS) scores were compared between patients not and still suffering from spasm. Moreover, the multiple logistic regression model was employed in assessing the relationship between preoperative HARS as well as HDRS scores and outcomes of adolescent cases undergoing MVD.The preoperative HARS and HDRS scores showed positive correlation with Cohen spasm grades in HFS patients. Meanwhile, compared with spasm-free group, patients of persistent spams group had apparently higher preoperative HARS and HDRS scores.Our results suggest that, preoperative anxiety and depression status show close association with HFS severity, and they could also impact the MVD outcomes for adolescent cases.
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Hughes MA, Traylor KS, Branstetter Iv BF, Eubanks KP, Chang YF, Sekula RF. Imaging predictors of successful surgical treatment of hemifacial spasm. Brain Commun 2021; 3:fcab146. [PMID: 34396106 PMCID: PMC8361424 DOI: 10.1093/braincomms/fcab146] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/17/2021] [Accepted: 05/17/2021] [Indexed: 11/14/2022] Open
Abstract
Identify preoperative imaging findings in hemifacial spasm patients that predict the post-surgical success following microvascular decompression. This is a retrospective study of patients who were diagnosed with hemifacial spasm, had a dedicated cranial nerve MRI, and underwent microvascular decompression for hemifacial spasm. Bilateral facial nerves were interrogated for neurovascular compression. If neurovascular compression was identified, we recorded whether the offending vessel was an artery, a vein or both. The location of the neurovascular compression (proximal nerve versus distal nerve) was noted. The severity of the neurovascular compression was categorized as contact versus deformity of the nerve. Patients were contacted to determine their post-operative spasm status. The relationships between imaging findings and post-surgical outcome were assessed by Chi-square tests, and odds ratios were calculated to quantify the degree of association. The study included 212 patients. Upon follow up, 192 patients were spasm free (90.57%). Imaging findings on the symptomatic side were as follows: arterial neurovascular compression was seen in 207 patients (97.64%), venous only neurovascular compression in two patients (0.94%), and no neurovascular compression in three patients (1.42%). Arterial neurovascular compression along the proximal, susceptible segment of the nerve was observed in 202 patients (95.28%); deformity was observed more commonly than contact alone. Arterial neurovascular compression along the distal segment only of the nerve was observed in five patients (2.36%). In patients with arterial neurovascular compression of the proximal and distal portions of the nerve, 93.07% and 60.0% of patients were spasm-free respectively. If venous neurovascular compression only was observed on imaging, 0% of patients were spasm-free. Patients with arterial neurovascular compression of the susceptible segment are much more likely to be spasm free than patients without this imaging finding, [odds ratio 20.14 (CI 5.08, 79.81), P-value <0.0001]. When comparing the two groups of arterial neurovascular compression (deformity versus contact), no statistically significant difference in outcomes was observed. In patients with hemifacial spasm undergoing microvascular decompression, imaging findings do predict surgical outcome. Patients with arterial neurovascular compression of the proximal, susceptible portion of the nerve are much more likely to be spasm free after surgery than those without this imaging finding. The imaging findings inform the risk benefit analysis and discussion with patients before they undergo microvascular decompression for hemifacial spasm.
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Affiliation(s)
- Marion A Hughes
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.,Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Katie S Traylor
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Barton F Branstetter Iv
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.,Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Komal P Eubanks
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Yue-Fang Chang
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Raymond F Sekula
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Efficacy of Second Operation for Hemifacial Spasm Within 1 Week After Ineffective Microvascular Decompression. J Craniofac Surg 2021; 32:e495-e498. [PMID: 33496517 DOI: 10.1097/scs.0000000000007470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of the second operation within 1 week after ineffective microvascular decompression (MVD) for patients with primary hemifacial spasm (HFS), and to find out the causes of failure. METHODS The surgery records and postoperative follow-ups of 52 primary HFS patients who had poor relief of spasm after their first MVDs were investigated. Patients were divided into 2 groups. Group A included 46 patients (16 males and 30 females) that went through the second operation within 1 week after the failure of the first MVD. Group B included 6 patients (3 males and 3 females) which did not take the reoperation. The level of spasm of each patient was then re-evaluated 1 year after the first surgery. RESULTS Among 52 patients who had poor relief after the first MVD between April 2016 and October 2019, 46 patients underwent a second MVD within 1 week while 6 patients refused to take the reoperation. Their mean duration of HFS was 102.4 ± 57.9 months. During reoperations for patients in group A, we discovered additional sites of neurovascular compression in 11 cases (23.91%). Forty-five patients (97.82%) in group A achieved complete relief 1 year after the second surgery while there was 1 recurrent case. Four patients (66.67%) in group B achieved delayed relief 1 year after the first surgery, while the other 2 patients were still suffering facial spasm in the 1-year follow-up. Group A demonstrated higher relief rate compared to group B in the 1 year follow up (P = 0.032). Although no severe complications occurred on patients in both group, 4 of them suffered grade II facial palsy, and another 3 patients had developed mild temporary hearing loss on the operation side. CONCLUSION The second operation within 1 week after an ineffective MVD is safe and effective. Full revealing of root exit zone and making sure no neurovascular compression missed with abnormal muscle response monitoring are the keys to a successful MVD.
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Huang J, Zhan Y, Li Y, Jiang L, Wang K, Wu Z, Xie Y, Shi Q. The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm. Front Surg 2021; 8:685155. [PMID: 34395510 PMCID: PMC8355354 DOI: 10.3389/fsurg.2021.685155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: Microvascular decompression (MVD) surgery has been accepted as a minimally invasive surgical modality for the treatment of hemifacial spasm (HFS). However, the size of the bone window does not match the concept of minimally invasive. This study is aimed at evaluating the efficacy and safety of <2 cm micro-keyhole MVD. Methods: A total of 148 patients with HFS diagnosed in the First Affiliated Hospital of Chongqing Medical University from January 1, 2019, to July 1, 2020, who underwent MVD in the neurosurgery department of the hospital were collected. Surgery was performed by a retrosigmoid keyhole approach with the bone hole diameter <2 cm, which was named micro-keyhole MVD. The efficacy and safety of the micro-keyhole MVD were evaluated by statistical analysis of the efficacy of the micro-keyhole MVD and the incidence of postoperative complications. Results: The effect of micro-keyhole MVD was satisfying (cure or partial remission) in 97.2% (n = 144). The failure and recurrence rates were 2.7% (n = 4) and 0.6% (n = 1), respectively. Among them, immediate facial palsy, delayed facial palsy, hearing loss, and cerebrospinal fluid (CSF) leakage were found in 0.6% (n = 1), 8.1% (n = 12), 4.7% (n = 7), and 1.3% (n = 2). Only one patient developed cerebellar infarction, which was complicated by “moyamoya disease.” The micro-keyhole MVD in the treatment of HFS can achieve a high remission rate and reduce the incidence of surgical complications. Conclusion: Micro-keyhole MVD is a safe and effective minimally invasive treatment for HFS. This technique does not increase the incidence of cranial nerve injury. Meanwhile, it reduces the incidence of CSF leakage and hearing loss (HL).
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Affiliation(s)
- Jiashang Huang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Zhan
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kuan Wang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhimin Wu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanfeng Xie
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quanhong Shi
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Connors S, El Ahmadieh TY, Aoun SG, Barnett SL. Commentary: Hemifacial Spam: Endoscopic Assistance in Facial Nerve Decompression With Lateral Spread Response Corroboration: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E129-E130. [PMID: 33313860 DOI: 10.1093/ons/opaa387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/13/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Scott Connors
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Salah G Aoun
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Samuel L Barnett
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
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Chang B, Tang Y, Wei X, Li S. A New Application of Gelatin Sponge in the Treatment of Hemifacial Spasm by Microvascular Decompression: A Technical Note. J Neurol Surg A Cent Eur Neurosurg 2021; 83:183-186. [PMID: 34010981 DOI: 10.1055/s-0040-1720994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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Affiliation(s)
- Bowen Chang
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine Xinhua Hospital, Shanghai, China
| | - Yinda Tang
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine Xinhua Hospital, Shanghai, China
| | - Xiangyu Wei
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine Xinhua Hospital, Shanghai, China
| | - Shiting Li
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine Xinhua Hospital, Shanghai, China
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Mizobuchi Y, Nagahiro S, Kondo A, Arita K, Date I, Fujii Y, Fujimaki T, Hanaya R, Hasegawa M, Hatayama T, Hongo K, Inoue T, Kasuya H, Kobayashi M, Kohmura E, Matsushima T, Masuoka J, Morita A, Munemoto S, Nishizawa S, Okayama Y, Sato K, Shigeno T, Shimano H, Takeshima H, Tanabe H, Yamakami I. Prospective, Multicenter Clinical Study of Microvascular Decompression for Hemifacial Spasm. Neurosurgery 2021; 88:846-854. [PMID: 33469667 DOI: 10.1093/neuros/nyaa549] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Microvascular decompression (MVD) is the most effective procedure for hemifacial spasm (HFS). MVD results from nonspecialized or low-volume institutes are not always reliable. Most studies on MVD for HFS are retrospective and single centered; to the best of our knowledge, no prospective, multicenter studies exist. OBJECTIVE To evaluate short- and long-term outcomes and complications in patients who underwent MVD for HFS in specialized Japanese institutions, in this multicenter, prospective, cohort study. METHODS Included patients had undergone MVD for HFS in study centers between April 2012 and March 2015. Patients' postoperative grade of involuntary movements and complications were recorded postoperatively at 7 d (short-term) and at 1 (mid-term) and 3 (long-term) yr. RESULTS A total of 486 patients (150 men, 336 women; mean age 53.9 yr with 181 patients over 60 yr) were enrolled during the study period. Neuromonitoring was used in 96.3% of the cases. The complete cure rate of symptom relief, mortality rate, and complication rate at short-term follow-up were 70.6%, 0%, and 15%, respectively. The long-term follow-up was completed by 463 patients (95.3%); the complete cure rate of symptom relief and complication rate were 87.1% and 3.0%, respectively. CONCLUSION Our study revealed that under expert guidance and intraoperative neuromonitoring, the long-term curative effect rate of MVD for HFS is high, while complications are uncommon and usually transient. Our results indicate that MVD is an effective and safe treatment for patients with HFS, including elderly patients.
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Affiliation(s)
- Yoshifumi Mizobuchi
- Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan
| | - Shinji Nagahiro
- Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan
| | - Akinori Kondo
- Brain and Spine Surgery Center, Shiroyama Hospital, Osaka, Japan
| | - Kazunori Arita
- Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Isao Date
- Okayama University Graduate School of Medicine, Okayama, Japan
| | | | | | - Ryosuke Hanaya
- Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | | | | | | | - Tooru Inoue
- Graduate School of Medical Sciences, Fukuoka University, Fukuoka, Japan
| | - Hidetoshi Kasuya
- Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | | | - Eiji Kohmura
- Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Jun Masuoka
- Faculty of Medicine, Saga University, Saga, Japan
| | | | | | - Shigeru Nishizawa
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshihiro Okayama
- Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan
| | - Kimitoshi Sato
- Kitasato University School of Medicine, Sagamihara, Japan
| | | | - Hiroshi Shimano
- Brain and Spine Surgery Center, Shiroyama Hospital, Osaka, Japan
| | - Hideo Takeshima
- Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Yan X, Ma C, Gu J, Qu J, Quan J, Zhang X, Song Q, Zhou L. Facial root entry/exit zone contact in microvascular decompression for hemifacial spasm: a historical control study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:834. [PMID: 34164468 PMCID: PMC8184434 DOI: 10.21037/atm-20-7985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background 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 Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- Xianxia Yan
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chengwen Ma
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junxiang Gu
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianqiang Qu
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junjie Quan
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xi Zhang
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qin Song
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Le Zhou
- Department of Neurosurgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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