gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Improved outcome of microvascular decompression for hemifacial spasm by advanced pre-operative imaging and intra-operative EMG-monitoring of lateral spread

Verbesserung der klinischen Ergebnisse nach mikrovaskulärer Dekompression bei Hemispasmus faciei durch die Kombination moderner präoperativer Bildgebung und intraoperativem EMG-Monitoring des lateral spread

Meeting Abstract

  • corresponding author Barbara Bischoff - Neurochirurgische Klinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen
  • R. Naraghi - Neurochirurgische Klinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen
  • J. Romstöck - Neurochirurgische Klinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen
  • P. Hastreiter - Neurochirurgische Klinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen
  • C. Strauss - Neurochirurgische Klinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen
  • R. Fahlbusch - Neurochirurgische Klinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.02.09

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0163.shtml

Published: April 23, 2004

© 2004 Bischoff et al.
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Outline

Text

Objective

MVD for hemifacial spasm still presents a challenge regarding postoperative outcome. Insufficient improvement in a great proportion of patients undergoing MVD for hemifacial spasm is a limitation for this treatment. The effect of a combination of pre-operative imaging and intraoperative monitoring of lateral spread on the outcome is presented.

Methods

From 1991 to 2003 a consecutive series of 30 patients with MVD for hemifacial spasm is analysed retrospectively. Surgical technique consisted of a standard MVD in all cases. In 16 versus 14 cases lateral spread was monitored during surgery. Prior to surgery, depending on the available MRI technique, 12 patients received routine T1 and T2 MRI, 6 patients received high resolution MRI,12 patients received high resolution MRI with 3D-visualization. The immediate post-operative and the long-term outcome was analysed depending on the pre-operatively and intra-operatively applied monitoring.

Results

Patients without intra-operative monitoring had an immediate success rate of 8 (14) and 10 (14) on long-term. Two cases without immediate success became free of spasm on long-term. 16 patients with monitoring of lateral spread had an immediate post-operative relief of spasm (100%). In long-term the success rate was 14 (16). Correlating the outcome to the applied technology of imaging and image processing we found only 7(12) immediate relief and 8 (12) long-term improvement in the group of patients with routine T1 and T2 MRT. The combination of monitoring of lateral spread and advanced imaging resulted to an immediate relief in 100% and long-term improvement in 10 (12).

Conclusions

The positive effect of developing and introducing new technologies on the outcome of MVD for hemifacial spasm is demonstrated. The combination of preoperative advanced imaging technology and intraoperative monitoring of lateral spread can ensure favourable results by guiding the surgeon to the definite site of pathology.