Fully endoscopic microvascular decompression for hemifacial spasm

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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.

ABBREVIATIONS AICA = anterior inferior cerebellar artery; BAEP = brainstem auditory evoked potential; CPA = cerebellopontine angle; EA-MVD = endoscope-assisted MVD; E-MVD = endoscopic MVD; HFS = hemifacial spasm; IONM = intraoperative neuromonitoring; LSR = lateral spread response; MVD = microvascular decompression; PICA = posterior inferior cerebellar artery; VA = vertebral artery.

Article Information

Correspondence Tracy M. Flanders: University of Pennsylvania, Philadelphia, PA. tracy.flanders@uphs.upenn.edu.

INCLUDE WHEN CITING Published online October 5, 2018; DOI: 10.3171/2018.4.JNS172631.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Illustration of the operative technique employed by the senior author for the fully endoscopic approach. The position of the surgeon’s hands in relation to the endoscope with the Mitaka Pneumatic Arm has been well described in prior publications.23 Artist Eo Trueblood. Copyright Stream Studios at the Children’s Hospital of Philadelphia. Published with permission. Figure is available in color online only.

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    Resolution of lateral spread seen with IONM. Aqua indicates the baseline, and magenta indicates the most recent trace. Figure is available in color online only.

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