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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Outcome of microvascular decompression in management of hemifacial spasm caused by vertebrobasilar dolichoectasia – Case study

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  • Ehab El-Refaee - Department of Neurosurgery, University medicine Greifswald, Germany; Department of Neurosurgery, Cairo University, Cairo, Egypt
  • Christian Rosenstengel - Department of Neurosurgery, University medicine Greifswald, Germany
  • Soenke Langner - Institute of Radiology and Neuroradiology, University medicine Greifswald, Germany
  • Joerg Baldauf - Department of Neurosurgery, University medicine Greifswald, Germany
  • Marc Matthes - Department of Neurosurgery, University medicine Greifswald, Germany
  • Henry W. S. Schroeder - Department of Neurosurgery, University medicine Greifswald, Germany

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.08.02

doi: 10.3205/13dgnc063, urn:nbn:de:0183-13dgnc0630

Published: May 21, 2013

© 2013 El-Refaee et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Vertebrobasilar dolichoectasia (VBD) is a vascular anomaly that can be a rare cause of hemifacial spasm when the ectatic arteries exert compression on the brain stem at the facial nerve root exit zone (REZ). In this study, we evaluate the efficacy of microvascular decompression (MVD) in managing such rare form of severe neurovascular compression.

Method: This study included 16 consecutive patients with VBD where the VA was one of the offending vessels to the facial nerve. Reviewing MR images of all surgical hemifacial spasm patients in our institute between 2007-2011 (100 patients), so that patients with fulfilled criteria of VBD were selected. 17 MVD procedures to manage hemifacial spasm were performed. The mean follow-up period was 21 months. Effectiveness of MVD was evaluated with correlation to the post-operative clinical outcome.

Results: 14 out of 16 patients had an almost complete to complete resolution of spasms along the follow-up period. We found the interposing technique with teflon pledges effective in managing most of the cases with an overall success rate of 86.4 %. One patient experienced recurrence of symptoms and needed to be re-operated with implementation of the transposition-pexy technique with excellent outcome.

Conclusions: In this study, we address a rare vascular anomaly that caused brain stem compression and hemifacial spasm. We found the teflon interposing technique to be effective in managing most of the cases of hemifacial spasm associated with this anomaly.