Operative Complications of Microvascular Decompression for Hemifacial Spasm: Experience of 1548 Cases

Zhao, Hua; Zhang, Xin; Tang, Yinda; Zhang, Ying; Ying, Tiejin; Zhu, Jin; Li, Shiting

doi:10.1016/j.wneu.2017.08.028

Cited by 28 publications

(23 citation statements)

References 16 publications

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“…The incidence of dFNP paralysis has been reported to be from 2.8 to 22.5% ( 3 , 4 , 27 , 31 , 32 ), which is similar to the incidence of dFNP of 8.1% observed in the study. Possible causes of delayed facial paralysis include facial nerve exit zone injury via the Teflon felt, delayed facial nerve edema, activation of dormant viruses, or microcirculation disturbance due to vasospasm.…”

Section: Discussionsupporting

confidence: 87%

“…Hearing loss after MVD for HFS can occur for the following reasons: stretching of cranial nerve VIII during cerebellar retraction, direct trauma to the nerve caused by instruments or nearby coagulation, outer hair cell dysfunction due to drill-induced noise, compromised blood supply, and bone dust deposit during drilling and fluid entering into the opened mastoid air cell ( 13 , 23 – 25 ). In the present series, the incidence of HL was 4.7%, which was similar to the incidence of 2.7–12% reported in other literature ( 3 , 4 , 13 , 26 , 27 ), but the incidence of permanent HL ( n = 1, 0.6%) was lower than that reported in other literature ( 21 , 28 ). We speculated that it was related to the following factors: (1) a small and lower bone window could better avoid exposure to a mastoid air chamber.…”

Section: Discussionsupporting

confidence: 85%

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The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm

Huang

Zhan

et al. 2021

Front. Surg.

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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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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 85%

The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm

Huang

Zhan

et al. 2021

Front. Surg.

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“…Hearing loss, as well as facial palsy is commonly reported after MVD surgery (31)(32)(33)(34)(35)(36). The type of hearing loss in the present study could not be well defined, as the pure tone audiometry was not performed in every patient.…”

Section: Discomforts and Complicationsmentioning

confidence: 74%

Facial root entry/exit zone contact in microvascular decompression for hemifacial spasm: a historical control study

Yan

et al. 2021

Ann Transl Med

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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 REZcontact 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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“…The interpostion technique, involving the insertion of materials between offending arteries and the root exit zone of facial nerves, is also widely used. [ 11 ] For this technique, materials that can be used as permanent prostheses are required.…”

Section: Discussionmentioning

confidence: 99%

Prosthetic material degeneration over time as a possible factor in delayed recurrence of hemifacial spasm after successful microvascular decompression

Kondo¹,

Akiyama²,

Suzuki³

et al. 2018

Surg Neurol Int

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Background:The effectiveness of microvascular decompression in treating hemifacial spasm is widely accepted. However, some experience recurrence of hemifacial spasm after successful decompression surgery. Especially, delayed recurrence more than 5 years after surgery is rare and the cause of this phenomenon is unknown.Case Description:A female underwent microvascular decompression to treat her hemifacial spasm 6 years ago. Six years later, her hemifacial spasm recurred and she underwent a second surgery. The second surgery revealed that the sponge had become fragile, losing the ability to absorb the impact of pulsatile compression of the offending artery on the root exit zone of her facial nerve.Conclusion:We report a case in which degeneration of material, a sponge (polyurethane), used in decompression surgery caused delayed recurrence of hemifacial spasm. The selection of appropriate prosthetic materials is essential in such functional surgeries.

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Operative Complications of Microvascular Decompression for Hemifacial Spasm: Experience of 1548 Cases

Cited by 28 publications

References 16 publications

The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm

The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm

Facial root entry/exit zone contact in microvascular decompression for hemifacial spasm: a historical control study

Prosthetic material degeneration over time as a possible factor in delayed recurrence of hemifacial spasm after successful microvascular decompression

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