Endoscopic microvascular decompression without the use of rigid head fixation

Blue, Rachel; Alexis, Maya; Mensah-Brown, Kobina; Yang, Andrew; Spadola, Michael; Lee, John Y.K.

doi:10.1016/j.jocn.2022.10.030

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…The shoulder on the surgical side is pulled and fastened to the opposite side and the back, aiding in full exposure of the surgical area, and ensuring the assistant holds the mirror with minimal tilt. Some studies [ 30 ] have noted potential complications with three-point head pin fixation, such as changes in hemodynamics, skull fractures, and venous thromboembolism. Thus, it is essential to review the preoperative CT bone window position of the head when utilizing the three-point head pin.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative electrophysiological monitoring of the LSR of the facial nerve is vital during the procedure of fully endoscopic MVR [ 28 – 30 ], with some studies indicating that the LSR is a critical reference for assessing the short-term and long-term efficacy of MVD for facial muscle spasms. In cases utilizing LSR monitoring during surgery, patients exhibited notably improved postoperative outcomes compared with those that did not undergo monitoring of the LSR [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

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Fully endoscopic microvascular decompression for hemifacial spasm: a clinical study and analysis

Zheng,

Zhang,

Shao

et al. 2024

Neurosurg Rev

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Fully endoscopic microvascular decompression (MVD) of the facial nerve is the main surgical treatment for hemifacial spasm. However, the technique presents distinct surgical challenges. We retrospectively analyzed prior cases to consolidate surgical insights and assess clinical outcomes. Clinical data from 16 patients with facial nerve spasms treated at the Department of Neurosurgery in the First Affiliated Hospital of Bengbu Medical College, between August 2020 and July 2023, were retrospectively examined. Preoperatively, all patients underwent magnetic resonance angiography to detect any offending blood vessels; ascertain the relationship between offending vessels, facial nerves, and the brainstem; and detect any cerebellopontine angle lesions. Surgery involved endoscopic MVD of the facial nerve using a mini Sigmoid sinus posterior approach. Various operative nuances were summarized and analyzed, and clinical efficacy, including postoperative complications and the extent of relief from facial paralysis, was evaluated. Fully endoscopic MVD was completed in all patients, with the offending vessels identified and adequately padded during surgery. The offending vessels were anterior inferior cerebellar artery in 12 cases (75%), vertebral artery in 3 cases (18.75%), and posterior inferior cerebellar artery in 1 case (6.25%). Intraoperative electrophysiological monitoring revealed that the lateral spread response of the facial nerve vanished in 15 cases and remained unchanged in 1 case. Postoperative facial spasms were promptly alleviated in 15 cases (93.75%) and delayed in 1 case (6.25%). Two cases of postoperative complications were recorded—one intracranial infection and one case of tinnitus—both were resolved or mitigated with treatment. All patients were subject to follow-up, with no instances of recurrence or mortality. Fully endoscopic MVD of the facial nerve is safe and effective. Proficiency in endoscopy and surgical skills are vital for performing this procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fully endoscopic microvascular decompression for hemifacial spasm: a clinical study and analysis

Zheng,

Zhang,

Shao

et al. 2024

Neurosurg Rev

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show abstract

“…The shoulder on the surgical side is pulled and fastened to the opposite side and the back, aiding in full exposure of the surgical area and ensuring the assistant holds the mirror with minimal tilt. Some studies [23] have noted potential complications with three-point head pin xation, such as changes in hemodynamics, skull fractures, and venous thromboembolism. Thus, it's essential to review the preoperative CT bone window position of the head when utilizing the three-point head pin.…”

Section: Discussionmentioning

confidence: 99%

Fully Endoscopic Microvascular Decompression for Hemifacial Spasm: A Clinical Study and Analysis

Zheng,

Shao,

Cai

et al. 2023

Preprint

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Objective: Fully endoscopic microvascular decompression of the facial nerve is a pivotal surgical approach for treating hemifacial spasm. However, it presents distinct surgical challenges and necessitates a learning curve. Hence, this study aimed to consolidate surgical insights and assess clinical outcomes based on a retrospective analysis of prior cases. Methods: Clinical data from 16 patients with facial nerve spasms treated at the Department of Neurosurgery in the First Affiliated Hospital of Bengbu Medical College, between August 2020 and July 2023, were retrospectively examined. Preoperatively, all patients underwent magnetic resonance angiography to confirm the presence or absence of responsible blood vessels, ascertain the relationship between responsible blood vessels, facial nerves, and brainstem, and detect any cerebellopontine angle lesions. The surgical technique encompassed entirely endoscopic microvascular decompression of the facial nerve, employing a mini sigmoid sinus posterior approach. The operative nuances and clinical efficacy were summarized and analyzed. The former encompassed intraoperative positioning, incision design, bone window parameters, mirror-handling methodology, crucial points of collaboration between the surgeon and assistant, and intraoperative management of responsible blood vessels. The latter included typical postoperative complications and the extent of relief from facial paralysis. Results: All 16 patients successfully underwent the procedure, with the responsible blood vessels identified and adequately padded during surgery. These comprised 12 cases of anterior inferior cerebellar artery (75%), 3 cases of vertebral artery (18.75%), and 1 case of posterior inferior cerebellar artery (6.25%). Intraoperative electrophysiological monitoring of lateral spread response of the facial nerve entirely vanished in 15 cases and remained unchanged in 1 case. Postoperative facial spasms were promptly alleviated in 15 cases (93.75%) and delayed in 1 case (6.25%). Two cases of postoperative complications were recorded; one instance of intracranial infection, which resolved following lumbar cistern external drainage and anti-infective treatment, and one case of tinnitus, mitigated through oral administration of mecobalamin and nimodipine. All patients were subject to follow-up, with no instances of recurrence or mortality. Conclusion: Complete endoscopic microvascular decompression of the facial nerve proves to be both safe and effective. Proficiency in endoscopy and surgical skills are pivotal, thereby discouraging novices in endoscopy from performing this procedure.

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