Advances in microvascular decompression for hemifacial spasm

Zhiqiang Cui, Zhipei Ling, Zhiqiang Cui, Zhipei Ling

Abstract

Primary hemifacial spasm (HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone (REZ) from the brainstem. Numerous prospective and retrospective case series have confirmed the efficacy of microvascular decompression (MVD) of the facial nerve in patients with HFS. However, while MVD is effective, there are still significant postoperative complications. In this paper, recent technological advances related to MVD (such as lateral spread response, brainstem auditory evokes potential, three dimensional time of flight magnetic resonance angiography, intraoperative neuroendoscopy) are reviewed for the purposes of improving MVD treatment efficacy and reducing postoperative complications.

Keywords: Hemifacial spasm (HFS); Lateral spread response; Microvascular decompression (MVD); Neuroendoscopy; Three dimensional time of flight magnetic resonance angiography.

Figures

Fig. 1
Fig. 1
Triggered EMG from orbicularis oris (left) and orbicularis oculi (right). Note the disappearance of EMG activities from orbicularis oculi shortly after separation of the offending vessel from the facial nerve (red mark).
Fig. 2
Fig. 2
Recording of BAEP during a left side MVD procedure.
Fig. 3
Fig. 3
Reconstruction of left facial nerve and blood vessels before MVD using the 3D Slicer 4.3.0 software. A–B: Showing a close relation between the facial nerve REZ and anteroinferior cerebellar artery. C: 3D-TOF-MRA shows a small enhancing artery near the facial nerve root and brainstem. D: T2 imaging showing facial nerve REZ and projection.
Fig. 4
Fig. 4
A: Microscopic images showing noticeable tunnel vision disadvantage. B1–3: Neuroendoscopy allows examination of the facial nerve and offending vessel from various angles. B4–5: Endoscopy allows assessment of the location of Teflon separation graft and its relations to the facial nerve (black arrow head) as well as the offending vessel (white arrow head).

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