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Amagasaki K, Nishimura S, Uchida T, Tatebayashi K, Nakaguchi H. Infrafloccular approach effectively prevents hearing complication in microvascular decompression surgery for hemifacial spasm. Br J Neurosurg 2024; 38:863-866. [PMID: 34620013 DOI: 10.1080/02688697.2021.1988052] [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: 10/25/2020] [Revised: 06/30/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The infrafloccular approach in microvascular decompression (MVD) surgery for hemifacial spasm (HFS) was investigated for the prevention of hearing complications. METHODS Retrospective analysis of 136 patients who underwent MVD for HFS in 2019. The infrafloccular approach for MVD was adopted to resolve the symptom and protect hearing function. Postoperative hearing function was evaluated subjectively and objectively within 30 postoperative days, and later mainly subjectively. Postoperative condition of mastoid air cells based on the CT scan of the following day was also recorded. RESULTS No final postoperative subjective hearing impairment was found in all patients. Mastoid air cells were opened in 105 patients, and subjective hearing impairment was recorded in 57 patients within 30 postoperative days, but all improved later. Increases in thresholds of greater than 10 dB in air conduction were observed in 28 patients, including 26 of transient conductive hearing loss (increases in the threshold of less than or equal to 10 dB). The other 2 patients with increases in the threshold of greater than 10 dB in both air and bone conduction had improvement confirmed by later audiometry. CONCLUSIONS Infrafloccular approach in MVD for HFS provides a good hearing outcome. Inclusion of postoperative hearing conditions in the later period is ideal for a precise hearing evaluation.
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Affiliation(s)
| | | | - Tatsuya Uchida
- Department of Neurosurgery, Mitsui Memorial Hospital, Tokyo, Japan
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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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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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Singh H, Dua S, Dhar A, Katyar V. Curious Case of Acoustic Schwannoma of Middle Cranial Fossa: A Case Report. Brain Tumor Res Treat 2022; 10:43-47. [PMID: 35118848 PMCID: PMC8819459 DOI: 10.14791/btrt.2022.10.e21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/10/2021] [Accepted: 10/26/2021] [Indexed: 11/20/2022] Open
Abstract
Acoustic neuromas are the most common lesion in the cerebellopontine angle. The authors report a unique case of acoustic schwannoma, presenting in middle cranial fossa masquerading as meningioma in a 24-year-old man, presenting with headache and focal seizures. Contrast-enhanced MRI of the brain revealed a mass lesion of the right middle cranial fossa consistent with features of meningioma. Intraoperatively a well-defined tumor with attachment to anterior petrous bone was excised. In the immediate postoperative period, the patient developed right-sided hearing loss, which was proven to be retrochoclear hearing loss on brainstem evoked response audiometry. Histopathology findings were consistent with benign schwannoma. Acoustic schwannoma originating in an unusual location middle cranial fossa is a plausible explanation of such unusual occurrence. Such a case has never been reported in the literature.
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Affiliation(s)
- Hershdeep Singh
- Department of Neurosurgery, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Sanjeev Dua
- Department of Neurosurgery, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Anil Dhar
- Department of Neurosurgery, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Vikrant Katyar
- Department of Neurosurgery, Max Super Speciality Hospital, Patparganj, New Delhi, India
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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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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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Mastronardi L, Caputi F, Cacciotti G, Scavo CG, Roperto R, Sufianov A. Microvascular decompression for typical trigeminal neuralgia: Personal experience with intraoperative neuromonitoring with level-specific-CE-Chirp® brainstem auditory evoked potentials in preventing possible hearing loss. Surg Neurol Int 2020; 11:388. [PMID: 33408922 PMCID: PMC7771394 DOI: 10.25259/sni_702_2020] [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: 10/04/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Permanent hearing loss after posterior fossa microvascular decompression (MVD) for typical trigeminal neuralgia (TTN) is one of the possible complications of this procedure. Intraoperative brainstem auditory evoked potentials (BAEPs) are used for monitoring the function of cochlear nerve during cerebellopontine angle (CPA) microsurgery. Level-specific (LS)-CE-Chirp® BAEPs are the most recent evolution of classical click BAEP, performed both in clinical studies and during intraoperative neuromonitoring (IONM) of acoustic pathways during several neurosurgical procedures. Methods: Since February 2016, we routinely use LS-CE-Chirp® BAEPs for monitoring the function of cochlear nerve during CPA surgery, including MVD for trigeminal neuralgia. From September 2011 to December 2018, 71 MVDs for TTN were performed in our department, 47 without IONM of acoustic pathways (Group A), and, from February 2016, 24 with LS-CE-Chirp BAEP (Group B). Results: Two patients of Group A developed a permanent ipsilateral anacusia after MVD. In Group B, we did not observe any permanent acoustic deficit after surgery. In one case of Group B, during arachnoid dissection, intraoperative LS-CE-Chirp BAEP showed a temporary lag of V wave, resolved in 5 min after application of intracisternal diluted papaverine (0.3% solution without excipients). Conclusion: MVD is widely considered a definitive surgical procedure in the management of TTN. Even though posterior fossa MVD is a safe procedure, serious complications might occur. In particular, the use of IONM of acoustic pathways during MVD for TTN might contribute to prevention of postoperative hearing loss.
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Affiliation(s)
- Luciano Mastronardi
- Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy.,Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University under Ministry of Health, Russian Federation
| | - Franco Caputi
- Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy
| | - Guglielmo Cacciotti
- Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy
| | | | - Raffaelino Roperto
- Department of Neurosurgery, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy
| | - Albert Sufianov
- Department of Neurosurgery, Federal Center of Neurosurgery, Tyumen Oblast, Russian Federation.,Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University under Ministry of Health, Russian Federation
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Kumar A, Ansari A, Yamada Y, Kawase T, Kato Y. Hearing Outcomes after Microvascular Decompression for Hemifacial Spasm: An Institutional Experience. Asian J Neurosurg 2020; 15:344-348. [PMID: 32656130 PMCID: PMC7335139 DOI: 10.4103/ajns.ajns_362_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/03/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Hearing loss following microvascular decompression (MVD) for hemifacial spasm is one of the most dreaded complications. Several factors such as stretching of VIII cranial nerve, vasospasm of labyrinthine artery, and acoustic trauma due to drill noise may be considered in its causation. We evaluated the incidence and severity of hearing loss following MVD in hemifacial spasm and the factors which might be responsible for this complication. Methods A retrospective analysis of 30 patients operated for hemifacial spasm between January 1, 2014, and December 31, 2018, with at least 3 months of follow-up were included in the study. Retromastoid craniotomy was made, and Teflon was placed between involved vessel and VII nerve. Results Freedom from hemifacial spasm was noted in 27 of 30 patients. Moderate spasm persisted in one patient, which was controlled with medications. The recurrence was noted in 3 patients at 6 months follow-up. Postoperatively, hearing loss was found in one female patient. The offending vessel was both anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) loop, which was transpositioned during surgery, and the patient was spasm free postoperatively. Conclusion The incidence of hearing loss following MVD can be minimized using proper surgical techniques and various intraoperative adjuncts such as brainstem auditory evoked responses monitoring, use of endoscope, and indocyanine green or dual-image video angiography.
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Affiliation(s)
- Ambuj Kumar
- Department of Neurosurgery, NSCB Government Medical College, Superspeciality Hospital, Jabalpur, Madhya Pradesh, Japan
| | - Ahmed Ansari
- Department of Neurosurgery, UPUMS, Etawah, Uttar Pradesh, India
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University Banbuntane Hospital, Nagoya, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Fujita Health University Banbuntane Hospital, Nagoya, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Banbuntane Hospital, Nagoya, Japan
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Significance of wave I loss of brainstem auditory evoked potentials during microvascular decompression surgery for hemifacial spasm. Clin Neurophysiol 2020; 131:809-815. [DOI: 10.1016/j.clinph.2019.12.409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 11/20/2022]
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Flanders TM, Blue R, Roberts S, McShane BJ, Wilent B, Tambi V, Petrov D, Lee JYK. Fully endoscopic microvascular decompression for hemifacial spasm. J Neurosurg 2019; 131:813-819. [PMID: 30497190 DOI: 10.3171/2018.4.jns172631] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hemifacial spasm (HFS) is characterized by involuntary tonic and/or clonic contractions of facial nerve muscles. Fully endoscopic microvascular decompression (E-MVD) for HFS has not been widely adopted. This paper aims to illustrate the safety and efficacy of the fully endoscopic technique for HFS treatment. METHODS The authors conducted a single-center retrospective study of 27 patients (28 separate E-MVD cases; 1 patient had bilateral E-MVD) diagnosed with HFS who underwent fully E-MVD from January 2013 to October 2016. Intraoperative brainstem auditory evoked potentials and lateral spread resolution were reviewed. Outcome was based on the clinical status of the patient at the last contact point with the senior author. Complications were categorized as facial weakness, hearing loss, ataxia, dysphagia, or any adverse event able to be attributed to the surgical procedure. RESULTS HFS was relieved either completely or partially in the majority of cases (24 of 28, 85.7%). Of the 28 separate procedures, 17 (60.7%) resulted in complete resolution of symptoms, 4 (14.3%) resulted in near-complete resolution, 2 (7.1%) resulted in 50% reduction of symptoms, 1 (3.6%) resulted in minimal reduction, and 4 (14.3%) resulted in no relief. Of the 27 patients, 26 (96%) had no permanent postoperative complications. In multivariate logistic regression, the best predictor of greater than 50% resolution of spasm was resolution of intraoperative lateral spread response. CONCLUSIONS A fully E-MVD for HFS provides a safe and comprehensive view of the neurovascular conflict. Exclusive use of the endoscope in MVD is both safe and feasible in the treatment of HFS. Attention to lateral spread response monitoring remains an integral part of comprehensive neurosurgical management.
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Affiliation(s)
- Tracy M Flanders
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Rachel Blue
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Sanford Roberts
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Brendan J McShane
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | | | | | - Dmitriy Petrov
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - John Y K Lee
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Scavo CG, Roperto R, Cacciotti G, Corrivetti F, Mastronardi L. Prophylactic effect of topical diluted papaverine in preventing hearing loss during microvascular decompression for typical trigeminal neuralgia: Case report and technical note. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2019. [DOI: 10.1016/j.inat.2018.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bartindale M, Kircher M, Adams W, Balasubramanian N, Liles J, Bell J, Leonetti J. Hearing Loss following Posterior Fossa Microvascular Decompression: A Systematic Review. Otolaryngol Head Neck Surg 2018; 158:62-75. [PMID: 28895459 PMCID: PMC7147641 DOI: 10.1177/0194599817728878] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022]
Abstract
Objectives (1) Determine the prevalence of hearing loss following microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS). (2) Demonstrate factors that affect postoperative hearing outcomes after MVD. Data Sources PubMed-NCBI, Scopus, CINAHL, and PsycINFO databases from 1981 to 2016. Review Methods Systematic review of prospective cohort studies and retrospective reviews in which any type of hearing loss was recorded after MVD for TN or HFS. Three researchers extracted data regarding operative indications, procedures performed, and diagnostic tests employed. Discrepancies were resolved by mutual consensus. Results Sixty-nine references with 18,233 operations met inclusion criteria. There were 7093 patients treated for TN and 11,140 for HFS. The overall reported prevalence of hearing loss after MVD for TN and HFS was 5.58% and 8.25%, respectively. However, many of these studies relied on subjective measures of reporting hearing loss. In 23 studies with consistent perioperative audiograms, prevalence of hearing loss was 13.47% for TN and 13.39% for HFS, with no significant difference between indications ( P = .95). Studies using intraoperative brainstem auditory evoked potential monitoring were more likely to report hearing loss for TN (relative risk [RR], 2.28; P < .001) but not with HFS (RR, 0.88; P = .056). Conclusion Conductive and sensorineural hearing loss are important complications following posterior fossa MVD. Many studies have reported on hearing loss using either subjective measures and/or inconsistent audiometric testing. Routine perioperative audiogram protocols improve the detection of hearing loss and may more accurately represent the true risk of hearing loss after MVD for TN and HFS.
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Affiliation(s)
- Matthew Bartindale
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Matthew Kircher
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - William Adams
- Clinical Research Office—Division of Biostatistics, Loyola University Medical Center, Maywood, Illinois, USA
| | - Neelam Balasubramanian
- Clinical Research Office—Division of Biostatistics, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jeffrey Liles
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jason Bell
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - John Leonetti
- Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
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Ghali MGZ, Srinivasan VM, Viswanathan A. Microvascular Decompression for Hemifacial Spasm. Int Ophthalmol Clin 2018; 58:111-121. [PMID: 29239883 DOI: 10.1097/iio.0000000000000209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Jung NY, Lee SW, Park CK, Chang WS, Jung HH, Chang JW. Hearing Outcome Following Microvascular Decompression for Hemifacial Spasm: Series of 1434 Cases. World Neurosurg 2017; 108:566-571. [DOI: 10.1016/j.wneu.2017.09.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/08/2017] [Accepted: 09/09/2017] [Indexed: 10/18/2022]
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