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      Fully endoscopic microvascular decompression for hemifacial spasm

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          Abstract

          With the rapid development of endoscopic technology, fully endoscopic microvascular decompression (MVD) has been widely used in the treatment of hemifacial spasm (HFS), and has achieved good effect. The present study reviewed 5 cases of HFS treated by fully endoscopic MVD. After fully endoscopic MVD, the symptom of facial involuntary twitching was relieved in each of the 5 patients with an effective rate of 100%. Among the cases, 4 had no postoperative complications, such as cranial nerve dysfunction, and cerebellar or brainstem injury, while 1 patient had postoperative aseptic meningitis and recovered after follow-up treatment. In these 5 cases of MVD, endoscopy played an important role in identifying the offending blood vessels, which is of great significance to improve the surgical effect and safety. Furthermore, the postoperative effects showed that endoscopy has certain potential and advantages in MVD. Therefore, fully endoscopic MVD is also a feasible method for the treatment of HFS.

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          Hemifacial spasm: clinical findings and treatment.

          J. Jankovic, S Wang (1998)
          Hemifacial spasm (HFS) is a peripherally induced movement disorder characterized by involuntary, unilateral, intermittent, irregular, tonic or clonic contractions of muscles innervated by the ipsilateral facial nerve. We reviewed the clinical features and response to different treatments in 158 patients (61% women) with HFS evaluated at our Movement Disorders Clinic. The mean age at onset was 48.5+/-14.1 years (range: 15-87) and the mean duration of symptoms was 11.4+/-8.5 (range: 0.5-53) years. The left side was affected in 56% instances; 5 patients had bilateral HFS. The lower lid was the most common site of the initial involvement followed by cheek and perioral region. Involuntary eye closure which interfered with vision and social embarrassment were the most common complaints. HFS was associated with trigeminal neuralgia in 5.1% of the cases and 5.7% had prior history of Bell's palsy. Although vascular abnormalities, facial nerve injury, and intracranial tumor were responsible for symptoms in some patients, most patients had no apparent etiology. Botulinum toxin type A (BTX-A) injections, used in 110 patients, provided marked to moderate improvement in 95% of patients. Seven of the 25 (28%) patients who had microvascular decompression reported permanent complications and the HFS recurred in 5 (20%). Although occasionally troublesome, HFS is generally a benign disorder that can be treated effectively with either BTX-A or microvascular decompression.
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            Microvascular decompression for hemifacial spasm.

            E-h Jho, Peter J. Jannetta, M Larkins … (1995)
            The authors report the results of 782 microvascular decompression procedures for hemifacial spasm in 703 patients (705 sides), with follow-up study from 1 to 20 years (mean 8 years). Of 648 patients who had not undergone prior intracranial procedures for hemifacial spasm, 65% were women; their mean age was 52 years, and the mean preoperative duration of symptoms was 7 years. The onset of symptoms was typical in 92% and atypical in 8%. An additional 57 patients who had undergone prior microvascular decompression elsewhere were analyzed as a separate group. Patients were followed prospectively with annual questionnaires. Kaplan-Meier methods showed that among patients without prior microvascular decompression elsewhere, 84% had excellent results and 7% had partial success 10 years postoperatively. Subgroup analyses (Cox proportional hazards model) showed that men had better results than women, and patients with typical onset of symptoms had better results than those with atypical onset. Nearly all failures occurred within 24 months of operation; 9% of patients underwent reoperation for recurrent symptoms. Second microvascular decompression procedures were less successful, whether the first procedure was performed at Presbyterian-University Hospital or elsewhere, unless the procedure was performed within 30 days after the first microvascular decompression. Patient age, side and preoperative duration of symptoms, history of Bell's palsy, preoperative presence of facial weakness or synkinesis, and implant material used had no influence on postoperative results. Complications after the first microvascular decompression for hemifacial spasm included ipsilateral deaf ear in 2.6% and ipsilateral permanent, severe facial weakness in 0.9% of patients. Complications were more frequent in reoperated patients. In all, one operative death (0.1%) and two brainstem infarctions (0.3%) occurred. Microvascular decompression is a safe and definitive treatment for hemifacial spasm with proven long-term efficacy.
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              Microvascular decompression of cranial nerves: lessons learned after 4400 operations.

              Michael Resnick, Brian Subach, C Comey … (1998)
              Microvascular decompression has become an accepted surgical technique for the treatment of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and other cranial nerve rhizopathies. The senior author (P.J.J.) began performing this procedure in 1969 and has performed more than 4400 operations. The purpose of this article is to review some of the nuances of the technical aspects of this procedure. A review of 4415 operations shows that numerous modifications to the technique of microvascular decompression have occurred during the last 29 years. Of the 2420 operations performed for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia before 1990, cerebellar injury occurred in 21 cases (0.87%), hearing loss in 48 (1.98%), and cerebrospinal fluid (CSF) leakage in 59 cases (2.44%). Of the 1995 operations performed since 1990, cerebellar injuries declined to nine cases (0.45%), hearing loss to 16 (0.8%), and CSF leakage to 37 (1.85% p < 0.01, test for equality of distributions). The authors describe slight variations made to maximize surgical exposure and minimize potential complications in each of the six principal steps of this operation. These modifications have led to decreasing complication rates in recent years. Using the techniques described in this report, microvascular decompression is an extremely safe and effective treatment for many cranial nerve rhizopathies.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Exp Ther Med
                Journal ID (iso-abbrev): Exp Ther Med
                Journal ID (publisher-id): ETM
                Title: Experimental and Therapeutic Medicine
                Publisher: D.A. Spandidos
                ISSN (Print): 1792-0981
                ISSN (Electronic): 1792-1015
                Publication date Collection: July 2022
                Publication date (Electronic): 01 June 2022
                Publication date PMC-release: 01 June 2022
                Volume: 24
                Issue: 1
                Electronic Location Identifier: 483
                Affiliations
                Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, P.R. China
                Author notes
                Correspondence to: Professor Nan Wu, Department of Neurosurgery, Chongqing General Hospital, 118 Xingguang Boulevard, Liang Jiang New Area, Chongqing 401147, P.R. China wunan881@ 123456tmmu.edu.cn
                Article
                Publisher ID: ETM-24-1-11410
                DOI: 10.3892/etm.2022.11410
                PMC ID: 9214605
                PubMed ID: 35761812
                SO-VID: d8929299-9f19-4527-bb32-40eecdc95719
                Copyright © Copyright: © Jiang et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                Date received : 22 March 2022
                Date accepted : 10 May 2022
                Funding
                Funding: No funding was received.
                Categories
                Subject: Articles

                ScienceOpen disciplines: Medicine
                Keywords: endoscopy,microvascular decompression,hemifacial spasm
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: endoscopy, microvascular decompression, hemifacial spasm

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