Fully Endoscopic MVD Approach for Hemifacial Spasm

Objective Hemifacial spasm (HFS) is a debilitating disease of involuntary facial contractions. Fully endoscopic microvascular decompression (E-MVD) is a novel technique that can be employed in place of the conventional neurosurgical microscope. In trigeminal neuralgia, E-MVD has been shown to reduce postoperative headaches. We performed E-MVD in patients with HFS and hypothesized that the procedure would be at least equivalent to prior published results.

Methods We performed a retrospective chart review of patients who underwent surgery at Penn by a senior author (J.Y.L.) from January 2013 to October 2016. Outcome was based on the clinical status of the patient at the last contact point with the senior author. Intraoperative brainstem auditory-evoked potentials (BAEPs) were reviewed.

Results Of the 27 patients (28 separate E-MVD cases, one patient had bilateral E-MVD) diagnosed with HFS and 24 patients (85.7%) experienced complete or partial relief. Of the 28 separate cases, 17 (60.7%) experienced complete resolution of symptoms, 4 (14.3%) had near-complete resolution, 2 (7.1.%) resulted in 50% reduction, 1 (3.6%) resulted in minimal reduction, and 4 (14.3%) resulted in no relief. The average OR time was 119.7 minutes (range: 87–206 minutes). Nineteen of the 28 cases (67.9%) were notable for BAEP changes, of which 5 (26.3%) returned to baseline and 14 (73.7%) returned to near baseline at dural closure. Only one patient had a permanent complication—hearing loss despite no change in intraoperative BAEPs. The neurovascular conflict was attributed to the following vessels: 19 (67.9%) AICA, 2 AICA and another vessel (7.1%: AICA and VA, AICA, and brainstem perforator), 3 (10.7%) other (transverse pontine vein or small arteriole, VA, VA, and PICA), 4 (14.3%) unknown.

Conclusion Fully endoscopic microvascular decompression can be performed safely and effectively in patients with cranial nerve compression disorders such as hemifacial spasm.