Article
Endoscope-assisted microvascular decompression in hemifacial spasm
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Authors
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Henry W. S. Schroeder
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Christian Rosenstengel
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Marc Matthes
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Ehab El Refaee
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Jörg Baldauf
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: To evaluate the value of endoscope assistance in microvascular decompression for hemifacial spasm.
Methods: 281 patients (177 females, 104 males, mean age 55 years) suffering from hemifacial spasm underwent an endoscope-assisted microvascular decompression via a lower retrosigmoid approach. The spasm was left in 169 patients and right in 112 patients.
Results: The use of the endoscope was safe. There was no endoscope-related nerve or vessel injury and morbidity respectively. In 48 patients, the AEP were affected while dissecting under microscopic visualization. In contrast, all vascular compression sites were identified without any retraction with the 30° or 45° endoscope. The entire course of the facial nerve could be observed. In 278 patients, we found a typical arterial compression of the root exit zone of the facial nerve. The offending vessel was AICA (75), PICA (90), VA (7) and combined compression by VA/PICA (29), VA/AICA (32), PICA/AICA (21), VA/PICA/AICA (9), and AICA/BA (1). In one patient, we found a vein, and in 6 patients a venous/arterial sandwich compression (3 AICA/vein and 3 PICA/vein). More than half of the patients (151) were spasm-free immediately after surgery. In 167 patients, we have a follow-up time of 12 months. In 145 patients (87 %), the spasm disappeared. In 16 patients, the spasm improved by at least 50 %. In 4 patients, there was no significant improvement. In all of these patients, we found anatomic anomalies or a severe compression with morphological damage of the facial nerve. One patient died due to herpes encephalitis 14 days after surgery. In 84 patients (30 %), neurological deficits occurred after surgery, but these were permanent only in 9 patients (4 %) (5 anacusis, 6 hypacusis, 1 dizziness).
Conclusion: The endoscope-assisted microsurgical technique to decompress the facial nerve is a safe technique. The use of endoscopes improves the visualization of the nerve in its entire course through the subarachnoid space without any retraction. Especially in far dorsomedially located compression sites, the endoscope was invaluable to inspect the compression site.
