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Al Mutawa M, Matthes M, Schroeder HWS, Weidemeier ME. Etiology and Management of Recurrent and Persistent Hemifacial Spasm-A Single-Center Experience. Neurosurgery 2024; 95:418-427. [PMID: 38456708 DOI: 10.1227/neu.0000000000002894] [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: 10/16/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite a 90% success rate, microvascular decompression occasionally fails to resolve hemifacial spasm (HFS), necessitating revision surgery. We investigated recurrent cases to identify underlying causes. METHODS We evaluated patients at our institution who underwent revision microvascular decompression because of recurrent or persistent HFS, assessing recurrence causes, decompression techniques, complications, and outcomes. Data considered included demographics, preoperative symptoms, disease duration, offending vessel, and magnetic resonance findings. Surgical notes and intraoperative videos were reviewed, and telephone interviews were conducted for recent outcomes. RESULTS Out of our ongoing series of 493 patients, 43 patients (8.7%) required revision surgery with a patient cohort of 33 females and 10 males. The average symptom duration was 10 years. The median time between primary and revision surgery was 14 months. Thirteen patients (30.2%) underwent initial surgery elsewhere. Adhesions of Teflon pledgets to the facial nerve were the primary cause of nonresolution in 23 patients (53.5%), while in 13 (30.2%), a missed vascular compression was identified. Sixteen patients (37.2%) had sufficient decompression by removing the conflicting pledgets. During 10 revisions (23.3%), additional Teflon pledgets were necessary. After a median follow-up of 67 months after revision surgery, 27 patients (62.8%) reported complete spasm resolution. Six patients (14.0%) had a good outcome with over 90% reduction of their spasms, 3 patients (7.0%) stated a fair outcome (50% improvement), while 7 patients (16.3%) had no improvement. CONCLUSION According to our results, adhesions of Teflon to the facial nerve may cause HFS recurrence. Therefore, whenever possible, Teflon should be placed without nerve contact between the brainstem and the offending vessel. Using a sling or bridge technique seems to be beneficial because it leaves the facial nerve completely free. Persistent symptoms often result from missed offending vessels in the pontomedullary sulcus indicating the benefit of endoscopic inspection of this area with an endoscope.
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Affiliation(s)
- Mariam Al Mutawa
- Department of Neurosurgery, Jaber Al Ahmad Hospital, Kuwait City , Kuwait
- Department of Neurosurgery, University Medicine Greifswald, Greifswald , Germany
| | - Marc Matthes
- Department of Neurosurgery, University Medicine Greifswald, Greifswald , Germany
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald , Germany
| | - Martin E Weidemeier
- Department of Neurosurgery, University Medicine Greifswald, Greifswald , Germany
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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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Wei X, Wang J, Kong X, Gao C, Wang F. Effect of Microvascular Decompression of the Vagus Root Entry/Exit Zone on Blood Pressure in Patients with Hemifacial Spasm Associated with Essential Hypertension: A Retrospective Clinical Analysis. J Neurol Surg B Skull Base 2022; 83:e336-e342. [PMID: 35833003 DOI: 10.1055/s-0041-1729178] [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: 12/05/2020] [Accepted: 02/27/2021] [Indexed: 10/17/2022] Open
Abstract
Background This study aimed to evaluate blood pressure alterations after microvascular decompression (MVD) surgery in patients with hemifacial spasm (HFS) with coexisting hypertension (HTN). Methods A total of 56 patients with HFS with concurrent HTN who underwent MVD surgery in our center between 2015 and 2019 were retrospectively analyzed. Patients were divided into control and experimental groups: patients who received MVD treatment for only the facial nerve and those who received MVD for the affected facial nerve, ipsilateral vagus nerve, and adjacent ventrolateral medulla, respectively. Preoperative (3 days) and postoperative (7 days and 6 months) blood pressure measurements were analyzed. Results No statistically significant differences were observed in gender, age, HFS course, HTN course, HTN grade, and preoperative blood pressure between the two groups. No significant difference was observed between pre- and postoperative blood pressure in the control group. In the experimental group, systolic blood pressure significantly differed between 3 preoperative days and 7 postoperative days ( p < 0.05), as did diastolic blood pressure ( p < 0.05). Measurement at 6 postoperative months also showed significant differences for both systolic blood pressure and diastolic blood pressure compared with that at 3 preoperative days ( p < 0.05). HTN grade according to the World Health Organization classification criteria significantly differed between preoperative and postoperative measurements ( p < 0.05). Conclusion Vascular decompression of the ipsilateral vagus nerve roots may improve blood pressure management in patients with HFS with coexisting HTN who undergo MVD. Laterality of involvement (left vs. right) did not significantly differ.
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Affiliation(s)
- Xuefeng Wei
- Department of Neurosurgery, Ningxia Medical University, Yinchuan, China
| | - Jiao Wang
- Blood Purification Center, Wuxi No. 2 People's Hospital, Wuxi, China
| | - Xuerui Kong
- Department of Neurosurgery, Ningxia Medical University, Yinchuan, China
| | - Caibin Gao
- Department of Neurosurgery, General Hospital of Ning Xia Medical University, Yinchuan, China
| | - Feng Wang
- Department of Neurosurgery, General Hospital of Ning Xia Medical University, Yinchuan, China.,Ningxia Key Laboratory of Cerebrocranial Diseases, Yinchuan, China
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Xia YF, Zhou WP, Zhang Y, Li YZ, Wang XH, Li ST, Zhao H. How to Improve the Effect of Microvascular Decompression for Hemifacial Spasm: A Retrospective Study of 32 Cases with Unsuccessful First Time MVD. J Neurol Surg A Cent Eur Neurosurg 2021; 83:338-343. [PMID: 34781405 DOI: 10.1055/s-0041-1735855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Microvascular decompression (MVD) has become accepted as an effective therapeutic option for hemifacial spasm (HFS); however, the curative rate of MVD for HFS varies widely (50-98%) in different medical centers. This study could contribute to the improvement of the MVD procedure. METHODS We retrospectively analyzed 32 patients in whom initial MVD failed in other hospitals and who underwent a second MVD at our center. The clinical characteristics, operative findings, outcome of the second MVD, and complications were recorded. RESULTS There were 18 women and 14 men (56.3 and 43.7%, respectively). The left-to-right ratio was 19:13. The mean age of the patients was 59.8 years. We found an undiscovered conflict site located in zone 4 in 10 patients and in the root entry zone in 8 patients. The initial MVD failed in nine patients because of ignorance of the arterioles that originate from the anterior inferior cerebellar artery. There were no special findings in four patients. No Teflon felts were found in the whole surgical field in one patient. CONCLUSION Omission of the offending vessel is the most common cause of an unsuccessful MVD. Intraoperative abnormal muscle response associated with the Z-L response is a good measure to correctly identify the involved arterioles.
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Affiliation(s)
- Yun-Fei Xia
- Department of General, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Wei-Ping Zhou
- Department of Neurosurgery, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Ying Zhang
- Department of Orthopaedic, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Yan-Zhen Li
- Department of Neurosurgery, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Xu-Hui Wang
- Department of Neurosurgery, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Shi-Ting Li
- Department of Neurosurgery, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Hua Zhao
- Department of Neurosurgery, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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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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Zhao H, Zhu J, Tang YD, Shen L, Li ST. Hemifacial Spasm: Comparison of Results between Patients Older and Younger than 70 Years Operated on with Microvascular Decompression. J Neurol Surg A Cent Eur Neurosurg 2021; 83:118-121. [PMID: 34237777 DOI: 10.1055/s-0040-1721018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the efficacy and safety of microvascular decompression (MVD) for primary hemifacial spasm (HFS) in patients aged ≥70 years and to compare the outcome with a control cohort of younger patients(<70 years). METHODS In this retrospective study, subjects were divided into two groups: an elderly group (patients who were ≥70 years) and a younger group. We compared demographic and clinical data, surgical outcome, MVD-related complications, and duration of operation and hospitalization after MVD between the two groups. RESULTS At a mean follow-up of 32 ± 4.2 months, 188 elderly patients (90.4%) reported an effective outcome without need for any medication versus 379 (91.1%) of the younger cohort. There was no mortality in both cohorts. The prevalence of delayed facial palsy was 4.8% in the elderly group and 4.1% in the younger group. One (0.5%) patient in the elderly group and 3 (0.7%) patients in the younger group suffered cerebrospinal fluid (CSF) leakage. There was no significant difference between the two groups in terms of MVD-related complications, such as delayed facial palsy, hearing impairment, CSF leakage, and hematoma. CONCLUSIONS MVD is an effective treatment option in elderly patients with HFS as well as in younger patients. Age itself seems to be no relevant contraindication or, alternatively, risk factor regarding MVD.
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Affiliation(s)
- Hua Zhao
- Neurosurgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Zhu
- Neurosurgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yin-da Tang
- Neurosurgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Shen
- Neurosurgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi-Ting Li
- Neurosurgery Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Holste K, Sahyouni R, Teton Z, Chan AY, Englot DJ, Rolston JD. Spasm Freedom Following Microvascular Decompression for Hemifacial Spasm: Systematic Review and Meta-Analysis. World Neurosurg 2020; 139:e383-e390. [PMID: 32305605 PMCID: PMC7899163 DOI: 10.1016/j.wneu.2020.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) is a debilitating disorder characterized by intermittent involuntary movement of muscles innervated by the facial nerve. HFS is caused by neurovascular compression along the facial nerve root exit zone and can be treated by microvascular decompression (MVD). The goal was to determine rates and predictors of spasm freedom after MVD for HFS. METHODS A literature search using the key terms "microvascular decompression" and "hemifacial spasm" was performed. The primary outcome variable was spasm freedom at last follow-up. Analysis was completed to evaluate for variables associated with spasm-free outcome. RESULTS A total of 39 studies including 6249 patients were analyzed. Overall spasm freedom rate was 90.5% (5652/6249) at a follow-up of 1.25 ± 0.04 years. There was no significant relationship between spasm freedom versus persistent spasm and age at surgery, timing of follow-up, gender, disease duration, side of disease, or vessel type. Spasm freedom was more likely after an initial surgery versus a redo MVD (odds ratio 4.16, 95% confidence interval 1.99-8.68; P < 0.01). CONCLUSIONS MVD works well for HFS with cure rates >90% at 1-year follow-up in 6249 patients from 39 studies. A significant predictor of long-term spasm freedom at 1 year was an initial MVD as compared to repeat MVD. The majority of published manuscripts on MVD for HFS are heterogeneous single-institutional retrospective studies. As such, a large-scale meta-analysis reporting outcome rates and evaluating significant predictors of spasm freedom provides utility in the absence of randomized controlled studies.
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Affiliation(s)
- Katherine Holste
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Zoe Teton
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Alvin Y Chan
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
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Lee S, Park SK, Lee JA, Joo BE, Park K. Missed Culprits in Failed Microvascular Decompression Surgery for Hemifacial Spasm and Clinical Outcomes of Redo Surgery. World Neurosurg 2019; 129:e627-e633. [DOI: 10.1016/j.wneu.2019.05.231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
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Surgical Treatment of Secondary Hemifacial Spasm: Long-Term Follow-Up. World Neurosurg 2019; 125:e10-e15. [DOI: 10.1016/j.wneu.2018.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/18/2022]
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10
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Zhao H, Zhu J, Zhang X, Tang YD, Zhou P, Wang XH, Li S. Involved Small Arteries in Patients Who Underwent Microvascular Decompression for Hemifacial Spasm. World Neurosurg 2018; 118:e646-e650. [DOI: 10.1016/j.wneu.2018.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 06/30/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
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Xu XL, Zhen XK, Yuan Y, Liu HJ, Liu J, Xu J, Li XB, Zhang L, Yu YB. Long-Term Outcome of Repeat Microvascular Decompression for Hemifacial Spasm. World Neurosurg 2017; 110:e989-e997. [PMID: 29203317 DOI: 10.1016/j.wneu.2017.11.144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/23/2017] [Accepted: 11/25/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although repeat microvascular decompression (MVD) for hemifacial spasm (HFS) in patients with failed prior MVD is potentially curative, little is known about the long-term results of repeat MVD. We aimed to evaluate the long-term outcomes and complications after repeat MVD for HFS. METHODS We performed repeat MVD on 78 consecutive patients who had undergone a prior MVD >1 year previously. Follow-up data were available for 58 patients, with a median follow-up period of 8.6 years (range, 6.9-10.2 years). The patients were assessed for intraoperative findings, relief results, and complications at discharge and at follow-up, as well as the associations between the preoperative characteristics and outcomes. RESULTS At discharge, of 78 patients with repeat MVD, 72 (92.3%) achieved complete spasm resolution and 1 (2.6%) had significantly improved spasm resolution. Of all patients, 9% (7 of 78) presented short-term complications, including partial hearing loss, hemifacial paresis, and cerebrospinal fluid leak. At follow-up, 45 of 58 (77.6%) patients had complete relief and 10 of 58 (17.2%) had improved relief. Permanent complications occurred in 14 patients (24.1%), with partial hearing loss and mild hemifacial paresis being the most common. Despite the complications, 51 of 58 patients (91.4%) reported an excellent life quality. No significant correlation was found between preoperative characteristics, such as age, interval to prior MVD, or interval to recurrence, and outcomes including short-term or long-term relief results and complications. CONCLUSIONS Repeat MVD provides lasting relief for most patients with persistent or recurrent HFS, albeit with a relatively high complication rate.
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Affiliation(s)
- Xiao-Li Xu
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Xue-Ke Zhen
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Yue Yuan
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Hong-Ju Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Jiang Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Jun Xu
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Xiu-Bin Li
- Organ Transplantation Institute, The 309th Hospital of Chinese People's Liberation Army, Haidian District, Beijing, People's Republic of China
| | - Li Zhang
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Yan-Bing Yu
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China.
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Treatment of Posterior Inferior Cerebellar Artery Adhesion on Petrous Bone During Microvascular Decompression Procedure for Hemifacial Spasm: Technique Note. J Craniofac Surg 2017; 28:e551-e554. [PMID: 28863115 DOI: 10.1097/scs.0000000000003846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hemifacial spasm is a hyperactive cranial nerve disease mainly characterized by unilateral facial muscles paroxysmal, involuntary, irregular and clonic convulsion. Standard microvascular decompression is currently the most effective solution. During operation, it is pivotal to conduct a sharp dissection of arachnoid membrane around the caudal cranial nerves and facial, auditory nerves for fully exposure of pontomedullary sulcus, and lateral pontine region. In this article, the authors demonstrate a hemifacial spasm patient who underwent microvascular decompression successfully in their department. But the authors encountered a serious barrier to the exploration of facial nerve and its offending vessels before decompression and found that posterior inferior cerebellar artery tightly adhered to petrous bone and closely attached to a petrosal vein on cerebellar surface at the same time. The petrosal vein was also seriously stuck to petrous bone. To solve this practical difficulty, the authors employed sharp point knife blade and microsurgical scissors boldly to separate posterior inferior cerebellar artery from the dura mater of petrous bone bidirectionally and bipolar coagulation for effective hemostasis. And then the authors moderately dealt with the surface adhesion of cerebellum for smooth exploration instead of processing the petrosal vein attached to petrous bone because the authors did not want to sacrifice this vein. Relative to the routine microvascular decompression for hemifacial spasm, treatments of the adhensions before decompression were the key technology of this operation.
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Zhao H, Zhang X, Tang YD, Zhang Y, Ying TT, Zhu J, Li ST. Operative Complications of Microvascular Decompression for Hemifacial Spasm: Experience of 1548 Cases. World Neurosurg 2017; 107:559-564. [PMID: 28823667 DOI: 10.1016/j.wneu.2017.08.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although microvascular decompression (MVD) surgery is considered the gold standard treatment for hemifacial spasm, there are some MVD-related complications. METHODS We retrospectively reviewed 1548 patients with hemifacial spasm who underwent retromastoid suboccipital craniectomy with MVD from January 2009 to June 2013. All patients were followed for >2 years. RESULTS Excellent and good results were 92.5% and 4.2%, respectively. Postoperative complications were recorded in 16.09% (n = 249). There was no MVD-related mortality. After MVD surgery, the most frequent complications were occipital sensory disturbance (7.3%), facial nerve palsy (9.7%), and hearing impairment (3.5%). Other complications were as follows: cerebrospinal fluid leakage (n = 24), poor healing wound (n = 14), lower cranial nerve palsy (n = 12), wound infection (n = 4), and hemorrhage (n = 2). CONCLUSIONS MVD operation is a safe treatment for hemifacial spasm. Facial nerve palsy is the most common MVD-related complication; preservation of the lesser occipital nerve during MVD surgery can decrease the rate of occipital sensory disturbance. Permanent or serious complications are comparatively rare in MVD surgery.
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Affiliation(s)
- Hua Zhao
- Department of Neurosurgery, XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Zhang
- Department of Neurosurgery, XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yin-da Tang
- Department of Neurosurgery, XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Zhang
- Department of Orthopedics, XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting-Ting Ying
- Department of Neurosurgery, XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Zhu
- Department of Neurosurgery, XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shi-Ting Li
- Department of Neurosurgery, XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Zhao H, Zhang X, Zhang Y, Tang YD, Zhu J, Wang XH, Ying TT, Li ST. Results of Atypical Hemifacial Spasm with Microvascular Decompression: 14 Case Reports and Literature Review. World Neurosurg 2017; 105:605-611. [PMID: 28619495 DOI: 10.1016/j.wneu.2017.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few studies have examined atypical hemifacial spasm (AHFS), and the mechanism of AHFS remains unclear. In this study, we examined the etiology, prognosis, and treatment of AHFS. METHODS We retrospectively analyzed the clinical data for 14 consecutive patients that underwent microvascular decompression (MVD) for AHFS between January 2014 and December 2015. Clinical features, outcomes, and complications were evaluated. RESULTS The incidence of AHFS is 1.52%. There were no significant differences in sex, age, side and duration between the typical hemifacial spasm and AHFS. During the follow-up period, the effective rate of MVD for patients with AHFS was 92.3%. Three patients developed delayed facial nerve palsy postoperatively, 1 patient experienced occipital sensory disturbance, and 1 patient suffered hearing loss. CONCLUSIONS Most of the cases of AHFS studied here were caused by neurovascular conflict in zone IV of the facial nerve distal to the root entry zone. MVD surgery is the first choice treatment for AHFS.
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Affiliation(s)
- Hua Zhao
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Zhang
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Zhang
- Department of Orthopedics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yin-Da Tang
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Zhu
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu-Hui Wang
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting-Ting Ying
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi-Ting Li
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Electromyographically Guided Nerve Combing Makes Microvascular Decompression More Successful in Hemifacial Spasm with Persistent Abnormal Muscle Response. World Neurosurg 2017; 102:85-90. [DOI: 10.1016/j.wneu.2017.02.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 11/19/2022]
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