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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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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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Carrillo-Ruiz JD, Covaleda-Rodríguez JC, Díaz-Martínez JA, Vallejo-Estrella A, Navarro-Olvera JL, Velasco-Campos F, Armas-Salazar A, Cid-Rodríguez FX. Minimally Invasive Retrosigmoidal Parasterional Burr-Hole Approach: Technique and Neuropathic Pain Amelioration after Microvascular Decompression of the Trigeminal Nerve. Biomedicines 2023; 11:2707. [PMID: 37893080 PMCID: PMC10603898 DOI: 10.3390/biomedicines11102707] [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: 05/24/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia, a common condition in clinical practice, often occurs due to vascular compression caused by aberrant or ectopic arterial or venous vessels. Microvascular decompression through a minimally invasive retrosigmoidal approach has shown high rates of pain control, low complication rates, and excellent therapeutic results. OBJECTIVE To describe the surgical technique and clinical outcomes in terms of pain relief after microvascular decompression of the trigeminal nerve through a minimally invasive retrosigmoidal parasterional burr-hole technique. METHODS A group of patients with trigeminal neuralgia refractory to medical management who underwent microvascular decompression were examined. The records of the patients were considered retrospectively (2016-2018), and the outcomes were considered based on the Visual Analogue Scale (VAS) and the Barrow Neurological Institute Pain Scale (BNIPS) added to a technical note of the surgical technique for a minimally invasive retrosigmoidal parasterional burr-hole. RESULTS Twenty-two patients were evaluated, and clinical assessment after surgical intervention showed a decrease in pain according to the VAS, resulting from an average preoperative state of 9.5 ± 0.37 to a postoperative condition of 1.32 ± 1.28, exhibiting statistically significant changes (p < 0.0001, d = 9.356). On the other hand, in relation to the BNIPS scale, a decrease from an average preoperative status of 4.55 ± 0.25 to a postoperative status at 12 months of 1.73 ± 0.54 was also demonstrated, showing significant changes (p < 0.0001, d = 3.960). CONCLUSION Microvascular decompression of the trigeminal nerve through a minimally invasive retrosigmoidal parasterional burr-hole is feasible and can be a safe and effective technique for the management of pain. However, further research employing larger sample sizes and longer follow-up periods is necessary.
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Affiliation(s)
- José Damián Carrillo-Ruiz
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Coordination of Neuroscience, Faculty of Psychology, Mexico Anahuac University, Mexico City 52786, Mexico
- Research Direction, General Hospital of Mexico, Mexico City 06720, Mexico
| | - Juan Camilo Covaleda-Rodríguez
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Unit of Functional Neurosurgery and Stereotactic, Olaya Polyclinic Center, Bogota 111411, Colombia
| | - José Armando Díaz-Martínez
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Department of Neurosurgery, Hospital Universitario “Dr. José Eleuterio González”, Monterrey 64460, Mexico
| | - Antonio Vallejo-Estrella
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
| | - José Luis Navarro-Olvera
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
| | - Francisco Velasco-Campos
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
| | - Armando Armas-Salazar
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Postgraduate Department, School of Higher Education in Medicine, National Polytechnic Institute, Mexico City 07360, Mexico
| | - Fátima Ximena Cid-Rodríguez
- Unit of Functional Neurosurgery, Stereotactic and Radiosurgery, General Hospital of Mexico, Mexico City 06720, Mexico; (J.C.C.-R.); (J.A.D.-M.); (A.V.-E.); (J.L.N.-O.); (F.V.-C.); (A.A.-S.); (F.X.C.-R.)
- Postgraduate Department, School of Higher Education in Medicine, National Polytechnic Institute, Mexico City 07360, Mexico
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Ujihara M, Kobayashi M, Hirata S, Takabatake K, Wakiya K, Fujimaki T. Bilateral Low-Frequency Hearing Impairment After Microvascular Decompression Surgery. Neurosurgery 2023; 93:662-669. [PMID: 36975375 DOI: 10.1227/neu.0000000000002469] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/30/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Hearing impairment is an important complication of microvascular decompression (MVD). In patients after MVD, we have occasionally noted slight to moderate hearing deterioration at low frequencies that is difficult to detect using pure tone average. OBJECTIVE To assess the incidence and features of low-frequency hearing impairment (LF-HI) after MVD and evaluate its associated factors. METHODS This single-center, retrospective observational study assessed the audiometric outcome of 270 patients who underwent MVD between January 2015 and December 2020. Preoperative and postoperative hearing levels were compared for each frequency. LF-HI was defined as a hearing deterioration of ≥15 dB at 125, 250, or 500 Hz. The incidence, symptoms, and associated factors of LF-HI were analyzed. RESULTS Statistical analysis of the patients overall demonstrated slight but significant decreases in the hearing level after MVD at lower frequencies on both the operative and contralateral sides. Eighty-one patients (30.0%) had LF-HI: 49 on the operative side, 24 on the contralateral side, and 8 on both sides, while pure tone average was worsened in 5 patients (1.8%). Subjective symptoms, including hearing deterioration, ear fullness, tinnitus, and dizziness, developed in 10.4% of the patients with LF-HI but improved subsequently within several weeks. "Older age" and "operative side" were associated with LF-HI. CONCLUSION Decreases in lower-frequency hearing levels in both the ipsilateral and contralateral (nonoperative) ears were observed after trigeminal neuralgia and hemifacial spasm surgery. LF-HI does not cause permanent symptoms but may be a noteworthy phenomenon, possibly involved in the contralateral hearing loss encountered occasionally after other types of posterior cranial fossa surgery.
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Affiliation(s)
- Masaki Ujihara
- Department of Neurosurgery, Saitama Medical University, Moroyama-machi, Saitama, Japan
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Zhang Y, Zhou E, Xue X, Chen X. Intraoperative brainstem auditory evoked potential monitoring during cerebellopontine angle surgery via retrosigmoid approach. EAR, NOSE & THROAT JOURNAL 2023:1455613221150574. [PMID: 36680392 DOI: 10.1177/01455613221150574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Brainstem auditory evoked potential (BAEP) monitoring was used to identify the influence of auditory function during cerebellopontine angle (CPA) surgery for cranial neuropathy via the retrosigmoid approach. METHODS This prospective study included 20 patients who underwent CPA surgery for cranial neuropathy via the retrosigmoid approach with intraoperative BAEP monitoring and pure tone audiometry (PTA). The latency and interpeak latency were analyzed at each surgical step in combination with the pre- and postoperative PTA. RESULTS Follow-up data were available for 17 patients. The mean pre- and postoperative PTA values were 25.65 dB and 20.70 dB, respectively. Two patients (2/17, 11.76%) developed hearing loss postoperatively. The latency of wave І significantly changed during direct auditory nerve manipulation and at the end of the surgery, while that of wave III only changed during direct auditory nerve manipulation. The appearance of wave V peak was delayed during CPA surgery. CONCLUSIONS CPA surgery for cranial neuropathy via the retrosigmoid approach can cause hearing loss to varying degrees, and intraoperative BAEP monitoring can reduce the occurrence of hearing loss. Intraoperative hearing function can be estimated by the latency of wave I. Hearing loss due to stretching of the brainstem can be estimated by the latency of wave III, and wave V is an early indicator of intraoperative hearing loss. Waves I and III remained stable both pre- and postoperatively, whereas wave V was unstable despite no surgery. Therefore, a precise operation and well-defined operative steps for surgeons during CPA surgery could facilitate maximal preservation of the anatomical structure and function.
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Affiliation(s)
- Yi Zhang
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Enhui Zhou
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Xiaocheng Xue
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Xiaoping Chen
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
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Malhotra R, Mudey A, Agrawal I. Clinical Features and Prognosis of Facial Palsy and Hearing Loss in Patients With Ramsay Hunt Syndrome. Cureus 2022; 14:e30897. [DOI: 10.7759/cureus.30897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
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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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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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Liu Y, Chen F, Li Z, Yang J, Zhang X, Chen L, Zhang L, Huang G. Microvascular decompression and aneurysm clipping for a patient with hemifacial spasm and ipsilateral labyrinthine artery aneurysm: A rare case report and literature review. CNS Neurosci Ther 2021; 28:307-309. [PMID: 34953034 PMCID: PMC8739036 DOI: 10.1111/cns.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yufei Liu
- Neurosurgical Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fanfan Chen
- Neurosurgical Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zongyang Li
- Neurosurgical Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jihu Yang
- Neurosurgical Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiejun Zhang
- Neurosurgical Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Lei Chen
- Neurosurgical Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Liwei Zhang
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guodong Huang
- Neurosurgical Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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Huang B, Yao M, Chen Q, Lin H, Du X, Huang H, Zhao X, Do H, Qian X. Awake CT-guided percutaneous stylomastoid foramen puncture and radiofrequency ablation of facial nerve for treatment of hemifacial spasm. J Neurosurg 2021; 135:1459-1465. [PMID: 33862595 DOI: 10.3171/2020.10.jns203209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hemifacial spasm (HFS) is a debilitating neuromuscular disorder with limited treatment options. The current study describes a novel minimally invasive procedure that provided effective and sustained relief for patients with HFS. The authors provide a detailed description of the awake CT-guided percutaneous radiofrequency ablation (RFA) of the facial nerve for treatment of HFS, and they examine its clinical efficacy. This is the first time in the literature that this procedure has been applied and systematically analyzed for HFS. METHODS Patients with a history of HFS were recruited between August 2018 and April 2020. Those with a history of cerebellopontine lesions, coagulopathy, ongoing pregnancy, cardiac pacemaker or defibrillator implants, or who declined the procedure were excluded from the study. Fifty-three patients who met the study criteria were included and underwent awake CT-guided RFA. Under minimal sedation, a radiofrequency (RF) needle was used to reach the stylomastoid foramen on the affected side under CT guidance, and the facial nerve was localized using a low-frequency stimulation current. Patients were instructed to engage facial muscles as a proxy for motor monitoring during RFA. Ablation stopped when the patients' hemifacial contracture resolved. Patients were kept for inpatient monitoring for 24 hours postoperatively and were followed up monthly to monitor resolution of HFS and complications for up to 19 months. RESULTS The average duration of the procedure was 32-34 minutes. Postoperatively, 91% of the patients (48/53) had complete resolution of HFS, whereas the remaining individuals had partial resolution. A total of 48 patients reported mild to moderate facial paralysis immediately post-RFA, but most resolved within 1 month. No other significant complication was observed during the study period. By the end of the study period, 5 patients had recurrence of mild HFS symptoms, whereas only 2 patients reported dissatisfaction with the treatment results. CONCLUSIONS The authors report for the first time that awake CT-guided RFA of the facial nerve at the stylomastoid foramen is a minimally invasive procedure and can be an effective treatment option for HFS.
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Affiliation(s)
- Bing Huang
- 1Department of Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang, People's Republic of China
| | - Ming Yao
- 1Department of Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang, People's Republic of China
| | - QiLiang Chen
- 2Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California
| | - Huidan Lin
- 3Department of Pain Medicine, The First Hospital of Ninbo, Zhejiang
| | - Xindan Du
- 4Department of Pain Medicine, Hangzhou Red Cross Hospital, Hangzhou
| | - Hao Huang
- 5Department of Pain Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou
| | - Xian Zhao
- 6Department of Pain Medicine, Shulan Hospital, Hangzhou, People's Republic of China; and
| | - Huy Do
- 7Department of Interventional Neuroradiology, Stanford University, Palo Alto, California
| | - Xiang Qian
- 2Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California
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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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Zeng C, Zhang C, Li YH, Feng X, Zhang MJ, Xiao RH, Yang HF. Recent Advances of Magnetic Resonance Neuroimaging in Trigeminal Neuralgia. Curr Pain Headache Rep 2021; 25:37. [PMID: 33821366 DOI: 10.1007/s11916-021-00957-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
Trigeminal neuralgia (TN) is a disease of unclear pathogenesis. It has a low incidence and is not fatal, but it can cause afflicted patients' depression or suicide. In the past, neurovascular compression was considered to be the main cause of TN, but recent studies have found that neurovascular contact is also common in asymptomatic patients and the asymptomatic side in symptomatic patients. This indicates that the neurovascular contact is not, or is only to a lesser extent, a factor in the development of TN. Thus, the study of the peripheral branches of the trigeminal nerve is necessary to understand the etiology of TN. With the development of imaging technology and the emergence of various imaging modalities, it is possible to study the etiology of TN and the pathological changes of related structures by magnetic resonance neuroimaging. This article reviews the recent advances in magnetic resonance neuroimaging of the trigeminal nerve.
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Affiliation(s)
- Chen Zeng
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan Province, China
| | - Chuan Zhang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan Province, China
| | - Ye-Han Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan Province, China
| | - Xu Feng
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan Province, China
| | - Man-Jing Zhang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan Province, China
| | - Ru-Hui Xiao
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan Province, China
| | - Han-Feng Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, 637000, Sichuan Province, 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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Martinez-Monedero R, Danielian A, Angajala V, Dinalo JE, Kezirian EJ. Methodological Quality of Systematic Reviews and Meta-analyses Published in High-Impact Otolaryngology Journals. Otolaryngol Head Neck Surg 2020; 163:892-905. [PMID: 32450783 DOI: 10.1177/0194599820924621] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the methodological quality of intervention-focused systematic reviews (SRs) and meta-analyses (MAs) published in high-impact otolaryngology journals. DATA SOURCES Ovid Medline, Embase, and Cochrane Library. REVIEW METHODS A comprehensive search was performed for SR and MA citations from 2012 to 2017 in the 10 highest impact factor otolaryngology journals. Abstracts were screened to identify published manuscripts in which the authors indicated clearly that they were performing an SR or MA. Applying a modified typology of reviews, 4 reviewers characterized the review type as SR, MA, or another review type. A simplified version of the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) tool was used to assess the reporting and methodological quality of the SRs and MAs that were focused on interventions. RESULTS Search and abstract screening generated 499 manuscripts that identified themselves as performing an SR or MA. A substantial number (85/499, 17%) were review types other than SRs or MAs, including 34 (7%) that were literature reviews. In total, 236 SRs and MAs focused on interventions. Over 50% of these SRs and MAs had weaknesses in at least 3 of the 16 items in the AMSTAR 2, and over 40% had weaknesses in at least 2 of the 7 critical domains. Ninety-nine percent of SRs and MAs provided critically low confidence in the results of the reviews. CONCLUSION Intervention-focused SRs and MAs published in high-impact otolaryngology journals have important methodological limitations that diminish confidence in the results of these reviews.
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Affiliation(s)
- Rodrigo Martinez-Monedero
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
| | - Arman Danielian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Varun Angajala
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Jennifer E Dinalo
- Health Sciences Libraries, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eric J Kezirian
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
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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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Tsunoda S, Inoue T, Naemura K, Akabane A. The efficacy of temporary clamping of V3 with a suboccipital far-lateral approach in microvascular decompression for Hemifacial spasm associated with the vertebral artery. Neurosurg Rev 2020; 44:625-631. [PMID: 32056025 DOI: 10.1007/s10143-020-01262-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/14/2020] [Accepted: 02/04/2020] [Indexed: 11/30/2022]
Abstract
Hemifacial spasm (HFS) is often caused by compression of the vertebral artery (VA) directly or indirectly as a result of other intervening vessels, so VA-associated HFS is difficult to treat. Recently, we have achieved good surgical outcomes using a far lateral approach and temporary clamping of V3 for VA-associated HFS. Herein, we present our method with an accompanying surgical video. From April 2018 to March 2019, 5 patients with VA-associated HFS underwent surgery, and pre-and postoperative symptoms and postoperative complications were evaluated. In the procedure, the suboccipital muscles were dissected and reflected layer by layer, and the extracranial VA (V3) was secured within the suboccipital triangle. A lateral suboccipital craniotomy followed by far lateral drilling was made to widen the surgical field from the caudolateral side. After reducing the VA flow pressure by temporary clamping of V3, the VA was transposed using a Teflon sling via two triangular space above and below the lower cranial nerves (LCNs). Causative vessels included direct VA compression in two cases and intervening vessels in three cases. The symptoms disappeared in four cases and improved satisfactorily in one case. One patient had mild hearing loss (approximately 10 dB) and hoarseness, but both improved 9 months after surgery. There was no postoperative cerebrospinal fluid leakage in any cases. A wide surgical field via the far lateral approach and the temporary clamping of V3 contributed to thorough observation of the REZ and safe and complete VA transposition.
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Affiliation(s)
- Sho Tsunoda
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan.
| | - Tomohiro Inoue
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
| | - Kazuaki Naemura
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
| | - Atsuya Akabane
- Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
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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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Hussain MA, Konteas A, Sunderland G, Franceschini P, Byrne P, Osman-Farah J, Eldridge P. Re-Exploration of Microvascular Decompression in Recurrent Trigeminal Neuralgia and Intraoperative Management Options. World Neurosurg 2018; 117:e67-e74. [DOI: 10.1016/j.wneu.2018.05.147] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 11/25/2022]
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20
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Krouse JH. Highlights from the Current Issue: January 2018. Otolaryngol Head Neck Surg 2018; 158:1-2. [PMID: 29297267 DOI: 10.1177/0194599817743496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- John H Krouse
- 1 School of Medicine, University of Texas Rio Grande Valley, Edinburg, Texas, USA
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