Treatment measures of difficult decompression during facial nerve microvascular decompression and its effect
ZHONG Jianwei, LI Yuhuan, HUANG Ruijing, SUN Yongfeng, SHI Lei, WANG Tao
Department of Military Medicine and Special Disciplines, Beijing Municipal Corps Hospital of Chinese People’s Armed Police Force, Beijing 100027, China
Abstract:Objective To investigate the treatment measures of difficult decompression in facial nerve microvascular decompression and its effect. Methods The clinical data of 31 patients with difficult decompression who underwent facial nerve microvascular decompression in Beijing Municipal Corps Hospital of Chinese People’s Armed Police Force from January 2019 to October 2023 were retrospectively analyzed. The types of difficult decompression such as intraoperative encephalocele, severe arachnoid adhesions and complex responsible blood vessels, were targeted and the surgical effects were observed. Results The symptoms of hemifacial spasm disappeared completely in 20 patients (66.66%), which was a complete remission. Seven patients (22.58%) still had facial spasm symptoms of varying degrees, which were partially relieved. Four cases (13.33%) had no change in symptoms. After 6 months of follow-up, 3 patients still had mild facial tics, which was significantly relieved than before surgery, and the overall cure rate was 90.33%. Conclusions In the case of difficult decompression during facial nerve microvascular decompression, a good surgical effect can be obtained through careful preoperative evaluation and flexible and diverse intraoperative difficult decompression measures.
Nugroho S W,Perkasa S A H,Gunawan K,et al.Predicting outcome of hemifacial spasm after microvascular decom pression with intraoperative monitoring: a systematic review[J]. Heliyon,2021,7(2):e06115.
[3]
Holste K,Sahyouni R,Teton Z, et al.Spasm freedom following microvascular decompression for hemifacial spasm; systematic reviewand meta-analysis[J]. World Neurosurg, 2020, 139: e383-e390
Park J S,Koh E J,Choi H Y,et al. Characteristic anatomical conforma tion of the vertebral artery causing vascular compression against the root exit zone of the facial nerve in patients with hemifacial spasm[J].Acta Neurochir(Wien),2015,157(3):449-454.
[6]
Sindou M,Mercier P. Microvascular decompression for hemifacial spasm:outcome on spasm and complications.A review[J].Neurochirurgie,2018,64(2):106-116.
Wilkinson M F,Chowdhury T,Mutch W A,et al.Analysis of facial motor evoked potentials for assessing a central mechanism in hemifacial spasm[J].J Neurosurg,2017,126:379.
[9]
Lee S,Joo K M,Park K. Challenging microvascular decompression surgery for hemifacial spasm[J]. World Neurosurg,2021,151: e94-e99.
[10]
Zhao K,Wang J W,Liu W H,et al.Flat-shaped posterior cranial fossa was associated with poor outcomes of microvascular decompression for primary hemifacial spasm[J]. Acta Neurochir (Wien),2020,162(II): 2801-2809.
[11]
Wilkinson M F,Kaufmann A M. Facial motor neuron excitability in hemifacial spasm:a facial MEP study[J].Can J Neurol Sci,2014, 41:239.
[12]
Mcgahan B G,Albnette-Felicio T,Kreatsoulas D C,et al.Simultaneous endoscopic and microscopic visualization in microvascular decompression for hemifacial spasm[J].Oper Neurosurg,2021,21(6):540-548.
[13]
Xue F,Shen Z,Wang Y,et al.Microvascular decompression for hemifacial spasm involving the vertebral artery:a modified effective technique using a gelatin sponge with a FuAiLe medical adhesive[J].CNS Neurosci Ther,2021,27(7):857-861.
[14]
El Refaee E,Fleck S,Matthes M,et al.Outcome of endoscope-assisted microvascular decompression in patients with hemifacial spasm caused by severe indentation of the brain stem at the pontomedullary sulcus by the posterior inferior cerebellar artery[J].Oper Neurosurg,2021,20(6):E399-E405.
[15]
Lee M H,Lee S,Park S K,et al.Delayed hearing loss after microvascular decompression for hemifacial spasm[J].Acta Neurochir,2019,161(3):503-508.
[16]
Lin C F,Hsu S P C,Pan S Y,et al.An easy adjustable sling technique of ectatic vertebral artery transposition for microvascular decom pression[J]. World Neurosurg,2021,154:78.