Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 833-838
DOI: 10.4103/ajns.AJNS_152_20
Review Article

Endoscopic microvascular decompression for hemifacial spasm

Maruf Matmusaev
Republican Specialized Scientific and Practical Medical Center of Neurosurgery, Tashkent
,
R Kumar
1   Department of Neurosurgery, Royal Care Super Speciality Hospital, Coimbatore, Tamil Nadu
,
Yasuhiro Yamada
2   Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya
,
Tetsuya Nagatani
3   Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya
,
Tsukasa Kawase
2   Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya
,
Riki Tanaka
2   Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya
,
Miyatani Kyosuke
2   Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya
,
Yoko Kato
2   Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Introduction and Objective: Hemifacial spasm (HFS) is a condition, characterized by painless, involuntary unilateral tonic or clonic contractions of the facial muscles innervated by the ipsilateral facial nerve. HFS starts with contractions in the orbicularis oculi muscle with subsequent eyelid closure and/or eyebrow elevation, but may spread to involve muscles of the frontalis, platysma, and orbicularis oris muscles. Microvascular decompression (MVD) is reliable and accepted surgical treatment for HFS. MVD is the standard surgical technique now for HFS treatment with long-term success rates. Materials and Methods: We performed fully endoscopic MVD technique for 1 patient with HFS (a 83-year-old female) at our institution. HFS was diagnosed based on the clinical history and presentation, a neurologic examination, and additional imaging findings. Respectively, the durations of HFS were 3 years, respectively. The patient had been previously treated with repeated botulinum toxin injections. Preoperative evaluation was done with magnetic resonance imaging; three-dimensional computed tomography fusion images examinations had identified the anterior inferior cerebellar artery (AICA) as the offending vessel in this patient. Results: The patient with HFS was treated by fully endoscopic MVD technique. The AICA, which had been identified as the offending vessel by preoperative magnetic resonance imaging, was successfully decompressed. No surgery-related complications occurred and had excellent outcomes with the complete resolution of HFS immediately after the operation. Conclusions: Endoscopic surgery can provide a more panoramic surgical view than conventional microscopic surgery. Fully endoscopic MVD is both safe and effective in the treatment of HFS. This method minimizes the risks of brain retraction and extensive dissection often required for microscopic exposure. Endoscopic MVD is safe and has advantage over microscope in terms of visualization of structure, identification of neurovascular conflict, but it has a learning curve and technically challenging.

Key-words:

Endoscope - facial nerve root exit zone - hemifacial spasm - microvascular decompression

Financial support and sponsorship

Nil.




Publication History

Received: 10 April 2020

Accepted: 28 May 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Wilkins RH. Hemifacial spasm: A review. Surg Neurol 1991;36:251-77.
  • 2 Wang A, Jankovic J. Hemifacial spasm: Clinical findings and treatment. Muscle Nerve 1998;21:1740-7.
  • 3 Campos-Benitez M, Kaufmann AM. Neurovascular compression findings in hemifacial spasm. J Neurosurg 2008;109:416-20.
  • 4 Lu AY, Yeung JT, Gerrard JL, Michaelides EM, Sekula RF Jr., Bulsara KR. Hemifacial spasm and neurovascular compression. ScientificWorldJournal 2014;2014:349319.
  • 5 Sekula RF Jr., Bhatia S, Frederickson AM, Jannetta PJ, Quigley MR, Small GA, et al. Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: A meta-analysis. Neurosurg Focus 2009;27:E10.
  • 6 Bigder MG, Kaufmann AM. Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: An analysis of reoperations. J Neurosurg 2016;124:90-5.
  • 7 Teton ZE, Blatt D, Holste K, Raslan AM, Burchiel KJ. Utilization of 3D imaging reconstructions and assessment of symptom-free survival after microvascular decompression of the facial nerve in hemifacial spasm. J Neurosurg 2019:1-8.
  • 8 Felício AC, Godeiro-Junior Cde O, Borges V, Silva SM, Ferraz HB. Bilateral hemifacial spasm: A series of 10 patients with literature review. Parkinsonism Relat Disord 2008;14:154-6.
  • 9 Peeraully T, Tan SF, Fook-Chong SM, Prakash KM, Tan EK. Headache in hemifacial spasm patients. Acta Neurol Scand 2013;127:e24-7.
  • 10 Park JS, Koh EJ, Choi HY, Lee JM. Characteristic anatomical conformation of the vertebral artery causing vascular compression against the root exit zone of the facial nerve in patients with hemifacial spasm. Acta Neurochir (Wien) 2015;157:449-54.
  • 11 Sindou M, Mercier P. Microvascular decompression for hemifacial spasm: Surgical techniques and intraoperative monitoring. Neurochirurgie 2018;64:133-43.
  • 12 Jannetta PJ, Abbasy M, Maroon JC, Ramos FM, Albin MS. Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg 1977;47:321-8.
  • 13 Dannenbaum M, Lega BC, Suki D, Harper RL, Yoshor D. Microvascular decompression for hemifacial spasm: Longterm results from 114 operations performed without neurophysiological monitoring. J Neurosurg 2008;109:410-5.
  • 14 Jho HD, Carrau RL. Endoscopy assisted transsphenoidal surgery for pituitary adenoma. Technical note. Acta Neurochir (Wien) 1996;138:1416-25.
  • 15 Adappa ND, Learned KO, Palmer JN, Newman JG, Lee JY. Radiographic enhancement of the nasoseptal flap does not predict postoperative cerebrospinal fluid leaks in endoscopic skull base reconstruction. Laryngoscope 2012;122:1226-34.
  • 16 Nagata Y, Watanabe T, Nagatani T, Takeuchi K, Chu J, Wakabayashi T. The Multiscope Technique for Microvascular Decompression. World Neurosurg 2017;103:310-4.
  • 17 Flanders TM, Blue R, Roberts S, McShane BJ, Wilent B, Tambi V, et al. Fully endoscopic microvascular decompression for hemifacial spasm. J Neurosurg 2018;131:813-9.
  • 18 Hanakita J, Kondo A. Serious complications of microvascular decompression operations for trigeminal neuralgia and hemifacial spasm. Neurosurgery 1988;22:348-52.
  • 19 Kureshi SA, Wilkins RH. Posterior fossa reexploration for persistent or recurrent trigeminal neuralgia or hemifacial spasm: Surgical findings and therapeutic implications. Neurosurgery 1998;43:1111-7.
  • 20 Sharma R, Garg K, Agarwal S, Agarwal D, Chandra PS, Kale SS, et al. Microvascular decompression for hemifacial spasm: A systematic review of vascular pathology, long term treatment efficacy and safety. Neurol India 2017;65:493-505.
  • 21 Komatsu F, Imai M, Hirayama A, Hotta K, Hayashi N, Oda S, et al. Endoscopic microvascular decompression with transposition for trigeminal neuralgia and hemifacial spasm: Technical note. J Neurol Surg A Cent Eur Neurosurg 2017;78:291-5.
  • 22 Ishikawa M, Tanaka Y, Watanabe E. Microvascular decompression under neuroendoscopic view in hemifacial spasm: Rostral-type compression and perforator-type compression. Acta Neurochir (Wien) 2015;157:329-32.
  • 23 Abolfotoh M, Bi WL, Hong CK, Almefty KK, Boskovitz A, Dunn IF, et al. The combined microscopic-endoscopic technique for radical resection of cerebellopontine angle tumors. J Neurosurg 2015;123:1301-11.