Microvascular decompression for hemifacial spasm: analyses of operative complications in 1582 consecutive patients

Huh, Ryoong; Han, In Ho; Moon, Ji Young; Chang, Jin Woo; Chung, Sang Sup

doi:10.1016/j.surneu.2007.07.027

Cited by 86 publications

(60 citation statements)

References 22 publications

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“…According to the previous reports, the success rate of MVD of the REZ utilizing Teflon is as high as 84-98.3 % 3,10,12) . The data from our hospital were obtained from a single surgeon's operations and recent results showed that the HFS caused by the small vessels had good prognosis in over 98% of the cases.…”

Section: Introductionmentioning

confidence: 93%

Microvascular Decompression for Hemifacial Spasm Associated with Vertebrobasilar Artery

Kim

Park

Choi

et al. 2008

J Korean Neurosurg Soc

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Section: Introductionmentioning

confidence: 93%

Microvascular Decompression for Hemifacial Spasm Associated with Vertebrobasilar Artery

Kim

Park

Choi

et al. 2008

J Korean Neurosurg Soc

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“…Deficits of the lower CNs were reported in 2.8% of HFS cases treated with MVD surgery. 4 We suspect that poor dissection around CNs IX and X is one possible cause of postoperative lower CN palsy. It is imperative that the lower CNs are separated from the arachnoid membrane, rhomboid lip, and choroid plexus.…”

Section: Discussionmentioning

confidence: 97%

“…The flocculus is gent ly retracted in a caudorostral direction perpendicular to CN VIII to avoid stretching that nerve and causing auditory nerve damage. 2,4,17 In this approach, the first steps performed under the operating microscope include resection of the arachnoid membrane around the jugular foramen and separation of CN IX from the choroid plexus. 3,7,8,10,11 During these procedures, we sometimes encounter the rhomboid lip, a thick membranous structure distinct from the arachnoid membrane.…”

mentioning

confidence: 99%

Importance of awareness of the rhomboid lip in microvascular decompression surgery for hemifacial spasm

Nakahara

Matsushima

Hiraishi

et al. 2013

JNS

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Object. The authors adopted the infrafloccular approach for microvascular decompression (MVD) surgery to treat hemifacial spasm (HFS). The inferior portion of the flocculus is retracted to observe the root exit zone of cranial nerve (CN) VII between CN IX and the flocculus. During the procedure, the rhomboid lip, a sheetlike layer of neural tissue forming the lateral recess of the fourth ventricle, is sometimes encountered. The existence of the rhomboid lip in cases of HFS was reviewed to determine the importance of the structure during MVD surgery.Methods. Preoperative imaging and intraoperative observations in 34 consecutive cases of HFS treated in the period from October 2008 through September 2011 were used to assess the frequency of encountering the rhomboid lip.Results. The rhomboid lip was observed during MVD surgery in 9 (26.5%) of the 34 cases but had been demonstrated on preoperative MR images in only 3 cases (8.8%). On T2weighted images, it appeared as a highintensity nonstructural area on the ventral side of the flocculus and continued into the fourth ventricle via the foramen of Luschka.Conclusions. A large rhomboid lip presents an impediment to MVD surgery in a significant minority of patients with HFS. It is seldom observed on preoperative MR images. Proper dissection of the rhomboid lip away from the arachnoid membrane and/or the lower CNs during MVD surgery provides good visualization of the root exit zone of CN VII and reduces injury of CNs IX and X, avoiding postoperative deficits like dysphagia.

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“…Huh ve ark. [17] 1524 hastalık HFS çalışmalarında ise başarı oranını %94.6 olarak bildirmişlerdir. Bizim çalışmamızda başarı oranı %96 oldu.…”

Section: Discussionunclassified

“…Huh ve ark. [17] 1524 hastadan oluşan çalışmalarında erken dönemde %35.8 oranında komplikasyon gördüklerini, en sık fasiyal paralizinin görüldüğünü bildirmişlerdir. Fakat uzun dönem kalıcı komplikasyon oranını %3.6 olarak bildirmişlerdir.…”

Section: Discussionunclassified

Vascular compression syndromes: our 24 year endoscope-assisted microvascular decompression experiences

Tutar

Şahin²,

Tutar³

et al. 2014

Kulak Burun Bogaz Ihtis Derg

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Amaç: Bu çalışmada hemifasiyal spazm, trigeminal nevralji, kokleovestibüler sinir kompresyonu gibi vasküler kompresyon sendromları nedeniyle yapılan endoskop yardımlı mikrovasküler dekompresyon deneyimlerimiz sunuldu. Hastalar ve Yöntemler:Mart 1999 -Haziran 2013 tarihleri arasında kliniğimizde vasküler kompresyon sendromları nedeniyle 55 hastaya (34 kadın, 21 erkek; ort. yaş 44 yıl; dağılım 24-77 yıl) endoskop yardımlı retrosigmoid yaklaşımla mikrosvasküler dekompresyon ameliyatı uygulandı. Tanı öykü, nörolojik muayene, manyetik rezonans görüntüleme bulguları ve odyovestibüler testler ile konuldu. Bulgular:Toplam 49 hastada (%89.1) tam iyileşme, iki hastada (%3.6) kısmi iyileşme, dört hastada (%7.3) ise semptomlarda düzelmeme görüldü. Sadece iki (%3.6) hastada ameliyat sırası komplikasyon olarak beyin omurilik sıvısı kaçağı gelişti. En sık bası yapan damarsal yapı ön ve alt serebellar arter olup, 14 hastada gözlendi. Esansiyel hipertansiyonlu dört hasta eş zamanlı sol medulla oblongata basısı dekomprese edildikten sonra normotansif oldu. Sonuç:Mikrovasküler kompresyon ameliyatı ile vasküler kompresyon sendromlu hastaların semptomlarında anlamlı iyileşme sağlanır. Ameliyat mikroskobuna yardımcı olarak açılı teleskopların kullanılması kraniyal sinire root entry zone bölgesinde bası nedenini saptamada önemli yardım sağlamaktadır.Anahtar Sözcükler: Endoskop yardımlı retrosigmoid yaklaşım; arka kraniyal fossa; retrosigmoid yaklaşım; root entry zone; vasküler kompresyon sendromları.Objectives: This study aims to report our experience on endoscope-assisted microvascular decompression experiences performed due to vascular compression syndromes such as hemifacial spasm, trigeminal neuralgia, and cochleovestibular nerve compression. Patients and Methods:Between March 1999 and June 2013, 55 patients (34 females, 21 males; mean age 44 years; range 24 to 77 years) underwent endoscope-assisted microvascular decompression surgery through a retrosigmoid approach due to vascular compression syndromes in our clinic. The diagnosis was based on history, neurological examination, magnetic resonance imaging findings and audio-vestibular tests.Results: A total of 49 patients (89.1%) had complete relief of the symptoms and two had (3.6%) a partial relief, while four had (7.3%) no relief of the symptoms. Only two patients had (3.6%) cerebrospinal fluid leakages as a perioperative complication. The major offending vessels were anterior and inferior cerebellar arteries in 14 patients. Four patients with essential hypertension became normotensive after decompression of the left medulla oblongata as well. Conclusion:Microvascular decompression surgery provides a significant relief of the symptoms in patients with vascular compression syndromes. An angled endoscope as an adjunct to microscope contributes to the diagnosis of the offending vessel in the root entry zone of the cranial nerve.

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Microvascular decompression for hemifacial spasm: analyses of operative complications in 1582 consecutive patients

Cited by 86 publications

References 22 publications

Microvascular Decompression for Hemifacial Spasm Associated with Vertebrobasilar Artery

Microvascular Decompression for Hemifacial Spasm Associated with Vertebrobasilar Artery

Importance of awareness of the rhomboid lip in microvascular decompression surgery for hemifacial spasm

Vascular compression syndromes: our 24 year endoscope-assisted microvascular decompression experiences

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