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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(04): 352-361
DOI: 10.1055/s-0038-1675764
Technical Note | Nota Técnica
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Microvascular Compressicaude by Slinging a Tortuous Vertebrobasilar Artery to the Petrous Dura in Hemifacial Spasm: Technical Note

Decupressão microvascular por derrame de uma artéria vértebro-basilar tortuosa a dura petrosa no espasmo hemifacial: Nota técnica
Forhad Hossain Chowdhury
1   Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
,
Mohammod Raziul Haque
1   Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
,
Jalal Uddin Mohammod Rumi
1   Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
,
Monir Hossain Reza
1   Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
› Author Affiliations
Further Information

Publication History

24 April 2018

10 July 2018

Publication Date:
12 December 2018 (online)

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Abstract

Objective In cases of hemifacial spasm caused by a tortuous vertebrobasilar artery (TVBA), the traditional treatment technique involves Teflon (polytetrafluoroethylene), which can be ineffective and fraught with recurrence and neurological complications. In such cases, there are various techniques of arteriopexy using adhesive compositions, ‘suspending loops’ made of synthetic materials, dural or fascial flaps, surgical sutures passed around or through the vascular adventitia, as well as fenestrated aneurysmal clips. In the present paper, we describe a new technique of slinging the vertebral artery (VA) to the petrous dura for microvascular decompression (MVD) in a patient with hemifacial spasm caused by a TVBA.

Method A 50-year-old taxi driver presented with a left-sided severe hemifacial spasm. A magnetic resonance imaging (MRI) scan of the brain showed a large tortuous left-sided vertebral artery impinging and compressing the exit/entry zone of the 7th and 8th nerve complex. After a craniotomy, a TVBA was found impinging and compressing the entry zone of the 7th and 8th nerve complex. Arachnoid bands attaching the artery to the nerve complex and the pons were released by sharp microdissection. Through the upper part of the incision, a 2.5 × 1 cm temporal fascia free flap was harvested. After the fixation of the free flap, a 6–0 prolene suture was passed through its length several times using the traditional Bengali sewing and stitching techniques to make embroidered quilts called Nakshi katha. The ‘prolenated’ fascia was passed around the compressing portion of the VA. Both ends of the fascia were brought together and stitched to the posterior petrous dura to keep the TVBA away from the 7th and 8th nerves and the pons.

Result The patient had no hemifacial spasm immediately after the recovery from the anesthesia. A postoperative MRI of the brain showed that the VA was away from the entry zone of the 7th and 8th nerves.

Conclusion The ‘prolenated’ temporal fascia slinging technique may be a very good option of MVD in cases in which the causative vessel is a TVBA.

Resumo

Objetivo Em casos de espasmo hemifacial causado por uma artéria vértebro-basilar tortuosa (AVBT), a técnica tradicional de tratamento envolve Teflon (politetrafluoretileno), que pode ser ineficaz e repleta de recorrência e complicações neurológicas. Nesses casos, existem várias técnicas de arteriopexia utilizando composições adesivas, “Laços de suspensão” feitos de materiais sintéticos, retalhos durais ou fasciais, suturas cirúrgicas passados ou através da adventícia vascular, bem como aneurismas fenestrados clipes. No presente artigo, descrevemos uma nova técnica de colagem da artéria vertebral (AV) à dura-máter para descompressão microvascular (DMV) em um paciente com espasmo hemifacial causado por um AVBT.

Método Um taxista de 50 anos apresentava um espasmo hemifacial grave do lado esquerdo. Uma ressonância magnética (RM) de varredura do cérebro mostrou uma grande artéria vertebral tortuosa do lado esquerdo, colidindo e comprimindo a zona de saída / entrada do sétimo e oitavo nervos complexos. Após uma craniotomia, um TVBA foi encontrado colidindo e comprimindo a zona de entrada do sétimo e oitavo nervos complexos. Bandas aracnóides ligando a artéria ao complexo nervoso e a ponte foram liberadas por microdissecção acentuada. Aravés de seu comprimento várias vezes usando as técnicas tradicionais de costura e costura Bengali para fazer colchas bordadas chamado Nakshi katha, a fachada "prolonada" foi passada em torno da porção de compressão da AV. Ambas as extremidades da fáscia foram unidas e costuradas à dura porção posterior petrosa para manter o AVBT longe do sétimo e oitavo nervos e da ponte.

Resultado O paciente não apresentou espasmo hemifacial imediatamente após a recuperação da anestesia. Uma ressonância magnética pós-operatória do cérebro mostrou que a AV estava longe da zona de entrada do sétimo e oitavo nervos.

Conclusão A técnica de sling de fáscia temporal “prolenada” pode ser uma opção muito boa de DMV nos casos em que o vaso causador é um AVBT.

Keywords

hemifacial spam - microvascular decompression slinging of the vertebral artery - arteriopexy to the petrous dura

Palavras-chave

spam hemifacial - descompressão microvascular slinging da artéria vertebral - arteriopexia a dura petrosa
 

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