J Neurol Surg B Skull Base 2015; 76(03): 202-207
DOI: 10.1055/s-0034-1396660
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Supine No-Retractor Method in Microvascular Decompression for Hemifacial Spasm: Results of 100 Consecutive Operations

Katsuyoshi Shimizu
1   Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
,
Masaki Matsumoto
1   Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
,
Akira Wada
1   Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
,
Tatsuya Sugiyama
1   Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
,
Daisuke Tanioka
1   Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
,
Hirotaka Okumura
1   Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
,
Hirotake Fujishima
1   Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
,
Takato Nakajo
1   Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
,
Sadayoshi Nakayama
1   Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
,
Hajime Yabuzaki
1   Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
,
Tohoru Mizutani
1   Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

15 August 2014

13 October 2014

Publication Date:
05 January 2015 (online)

Abstract

Objectives In microvascular decompression (MVD) for hemifacial spasm (HFS), the patient is placed in the lateral or park-bench position that is complicated and uncomfortable for anesthesiologists, nurses, and even the patient. Careless retraction of the cerebellum by a spatula could be the major cause of surgical complications. In our method, a patient is laid supine avoiding the complicated positioning. The subfloccular approach from a small cranial window sited on the more lateral and basal side of the occipital cranium enables the surgeon to reach all the segments of the facial nerve root without a spatula. We introduce our surgical procedures in detail along with our excellent results.

Methods A total of 100 consecutive patients experiencing primary HFS were operated on with MVD by a single surgeon in our institution from August 2012 to April 2014.

Results Overall, 94 patients showed the complete disappearance or a satisfactory alleviation of HFS. De novo neurologic deficits were not encountered after surgery including hearing impairment. In 47 cases, multiple offending vessels were observed in multiple possible affected sites in addition to the root entry/exit zone.

Conclusions We believe this approach is superior for the safe and precise decompression of any part of the facial nerve root.

 
  • References

  • 1 Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg 1967; 26 (1, Suppl): 159-162
  • 2 Neagoy DR, Dohn DF. Hemifacial spasm secondary to vascular compression of the facial nerve. Cleve Clin Q 1974; 41 (4) 205-214
  • 3 Ruby JR, Jannetta PJ. Hemifacial spasm: ultrastructural changes in the facial nerve induced by neurovascular compression. Surg Neurol 1975; 4 (4) 369-370
  • 4 Kondo A, Ishikawa J, Konishi T, Yamasaki T. Mechanism of vascular compression of cranial nerves—role of changes of vertebro-basilar vasculatures (author's transl) [in Japanese]. Neurol Med Chir (Tokyo) 1981; 21 (3) 287-293
  • 5 Tomii M, Onoue H, Yasue M, Tokudome S, Abe T. Microscopic measurement of the facial nerve root exit zone from central glial myelin to peripheral Schwann cell myelin. J Neurosurg 2003; 99 (1) 121-124
  • 6 Campos-Benitez M, Kaufmann AM. Neurovascular compression findings in hemifacial spasm. J Neurosurg 2008; 109 (3) 416-420
  • 7 De Ridder D, Møller A, Verlooy J, Cornelissen M, De Ridder L. Is the root entry/exit zone important in microvascular compression syndromes?. Neurosurgery 2002; 51 (2) 427-433 ; discussion 433–434
  • 8 Liang Q, Shi X, Wang Y, Sun Y, Wang R, Li S. Microvascular decompression for hemifacial spasm: technical notes on pontomedullary sulcus decompression. Acta Neurochir (Wien) 2012; 154 (9) 1621-1626
  • 9 Li Y, Zheng X, Hua X , et al. Surgical treatment of hemifacial spasm with zone-4 offending vessel. Acta Neurochir (Wien) 2013; 155 (5) 849-853
  • 10 Gardner WJ, Sava GA. Hemifacial spasm—a reversible pathophysiologic state. J Neurosurg 1962; 19 (3) 240-247
  • 11 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 (3) 321-328
  • 12 Lovely TJ. Efficacy and complications of microvascular decompression: a review. Neurosurg Q 1998; 8: 92-106
  • 13 Barker II FG, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD. Microvascular decompression for hemifacial spasm. J Neurosurg 1995; 82 (2) 201-210
  • 14 Jannetta PJ. Treatment of trigeminal neuralgia by microoperative decompression. In: Youmans JR, , ed. Neurological Surgery. Vol 6. 2nd ed. Philadelphia, PA: Saunders; 1982: 3589-3603
  • 15 McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK. Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 1999; 90 (1) 1-8
  • 16 Zhang M, Lee AS. The investing layer of the deep cervical fascia does not exist between the sternocleidomastoid and trapezius muscles. Otolaryngol Head Neck Surg 2002; 127 (5) 452-454
  • 17 Takahashi M. The anterior inferior cerebellar artery. In: Newton TH, Potts DG, , eds. Radiology of the Skull and Brain (Angiography). Book 2. St. Louis, MO: Mosby; 1974: 1796-1808
  • 18 Carlos R, Fukui M, Hasuo K , et al. Radiological analysis of hemifacial spasm with special reference to angiographic manifestations. Neuroradiology 1986; 28 (4) 288-295
  • 19 Adams CBT. Microvascular compression: an alternative view and hypothesis. J Neurosurg 1989; 70 (1) 1-12
  • 20 Guclu B, Sindou M, Meyronet D, Streichenberger N, Simon E, Mertens P. Cranial nerve vascular compression syndromes of the trigeminal, facial and vago-glossopharyngeal nerves: comparative anatomical study of the central myelin portion and transitional zone; correlations with incidences of corresponding hyperactive dysfunctional syndromes. Acta Neurochir (Wien) 2011; 153 (12) 2365-2375
  • 21 Jannetta PJ, McLaughlin MR, Casey KF. Technique of microvascular decompression. Technical note. Neurosurg Focus 2005; 18 (5) E5
  • 22 Kim EY, Park HS, Kim JJ, Lee SC, Ha CK, Park HC. A more basal approach in microvascular decompression for hemifacial spasm: the para-condylar fossa approach. Acta Neurochir (Wien) 2001; 143 (2) 141-144 ; discussion 145
  • 23 Hitotsumatsu T, Matsushima T, Inoue T. Microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia: three surgical approach variations: technical note. Neurosurgery 2003; 53 (6) 1436-1441 ; discussion 1442–1443
  • 24 Nishihara K, Hanakita J, Kinuta Y, Kondo A, Yamamoto Y, Nakatani H. Importance of intraoperative monitoring of ABR and compound action potential of the eighth cranial nerve during microvascular decompression surgery [in Japanese]. No Shinkei Geka 1986; 14 (4) 509-518
  • 25 Ishikawa M, Nakanishi T, Takamiya Y, Namiki J. Delayed resolution of residual hemifacial spasm after microvascular decompression operations. Neurosurgery 2001; 49 (4) 847-854 ; discussion 854–856
  • 26 Fukunaga A, Shimizu K, Yazaki T, Ochiai M. A recommendation on the basis of long-term follow-up results of our microvascular decompression operation for hemifacial spasm. Acta Neurochir (Wien) 2013; 155 (9) 1693-1697