Artikel
Microvascular decompression with vascular transposition technique assisted with intraoperative endoscope, experience in 517 operations
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Autoren
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T. Fujimaki
- Department of Neurosurgery, Saitama Medical University Hospital, Moroyama-machi, Japan
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M. Kobayashi
- Department of Neurosurgery, Saitama Medical University Hospital, Moroyama-machi, Japan
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M. Ohta
- Department of Neurosurgery, Saitama Medical University Hospital, Moroyama-machi, Japan
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Clinical features, the operative findings and postoperative courses after microvascular decompression (MVD) for hemifacial spasm (HFS) were analyzed.
Methods: Until September 30, 2011, consecutive 517 MVD procedures for 508 patients were performed by the same surgeon. With lateral position, through 5–6 cm skin incision, restrosigmoid craniotomy in 2.8 cm diameter was made. Lower cranial nerves were dissected to reach junction between IXth nerve and flocculus. The offending vessels of the root exit zone of VIIth nerve behind this space were identified by microscope and intraoperative endoscope with picture-in-picture system. The vessels were dissected and transposed with Teflon tape mostly together with small Teflon ball on the brainstem as an anchor for Teflon tape. Dural closure was done with fascial graft. Bone fragments were repositioned. No fibrin glue was used in recent 402 cases.
Results: 333 women and 175 men ranged from 21 years to 77 years (median 49 years) were included. The onset ranged from 15 years to 69 years. Hypertension was recorded preoperatively in 22.7%. PICA was the compressing artery in 40.8% followed by AICA (31.9%) and AICA-PICA (9.3%). Vertebral artery related compression was observed in 22.9% (overlap included.) Three patients (0.6%) had severe hearing disturbance and 1 patient have intractable vertigo. Symptomatic transient lower cranial nerve dysfunction was observed in 6 patients and remained in 2 (0.4%) of them. Grade 3 or more facial weakness was seen in 3 patients including 1 re-operation after other institution procedure (OI-reop). Thus long lasting morbidity was experienced in 1.8%. No CSF leak nor subcutaneous accumulation was observed. Time to resolution of HFS occured immediately or after a time interval up to 2 years. One year after surgery 422 patients (91.7%) experienced complete relief of HFS and another 9 patients cured after second surgery for persistent of recurrent HFS, thus totally 93.6% of the patients were cured.
Conclusions: MVD for HFS with vascular transposition technique with the aid of an endoscope is relatively safe and effective procedure with acceptable risk.
