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J Craniofac Surg. 2012 Sep;23(5):1385-7.

Microvascular decompression for hemifacial spasm.

Author information

1
Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, The Cranial Nerve Disease Center of Shanghai, Shanghai, China.

Abstract

OBJECTIVE:

Although microvascular decompression (MVD) has been accepted as effective therapy for hemifacial spasm, failed surgery has been reported frequently. For a sophisticated neurosurgeon, an apparent offending artery is seldom missed. However, it is still an embarrassed situation when the neurovascular conflict site could not be approached.

METHODS:

Clinical data were collected from consecutive 211 MVDs in 2010. Intraoperative abnormal muscle response was recorded. Among them, the neurovascular conflict was not finally discovered in 3 patients, whom were then focused on. All patients were followed up for 6 to 15 months.

RESULTS:

In 17 of the 211 MVDs, the cerebellum was hard to be retracted because of adhesions. After careful dissection, a working space was finally created in the cerebellopontine angle. However, there still were 3 cases, whose neurovascular conflict site was unable to be discovered at last because of a branch of an artery embedded in the petrous bone and made the cerebellum unmovable. With navigation of real-time abnormal muscle response, the offending artery was moved away eventually even without exposing the conflict site. Postoperatively, all the patients were completely spasm-free immediately. No recurrence was noticed in the last follow-up period.

CONCLUSIONS:

The most important thing for a successful MVD operation is to remove the offending artery off the nerve. However, if the conflict site failed to be approached after endeavors, a successful MVD can still be achieved by relocating the offending artery with the guidance of real-time electromyography even without visualization of the confliction.

PMID:
22948645
DOI:
10.1097/SCS.0b013e31825433d6
[Indexed for MEDLINE]

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