Hemifacial spasm: neurovascular compressive patterns and surgical significance

Park, J. S.; Kong, Doo‐Sik; Lee, J.-A.; Park, K.

doi:10.1007/s00701-007-1457-x

Cited by 76 publications

(46 citation statements)

References 25 publications

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“…36 As the neurovascular confliction theory has been accepted worldwide as the etiology of the disease, this process should give rise to an immediate pain free once the offending vessel was removed from the trigeminal nerve. 15,16,37,[61][62][63][64][65][66][67][68][69][70][71] Nevertheless, the common cure rate was found to be less than 90% in this research, which implied that this process needs to be further refined.…”

Section: Discussioncontrasting

confidence: 65%

Effectiveness and Safety of Microvascular Decompression Surgery for Treatment of Trigeminal Neuralgia

Xia¹,

Zhong²,

Zhu³

et al. 2014

Journal of Craniofacial Surgery

109

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Microvascular decompression has been now accepted worldwide as a reasonable treatment for trigeminal neuralgia, yet, as a functional operation in the cerebellopontine angle, this process may be risky and the postoperative outcomes might not be good enough sometimes. To assess the effectiveness and safety of microvascular decompression for treatment of trigeminal neuralgia, we conducted a systematic review. Using the keywords "trigeminal neuralgia", "microvascular decompression", or "neurovascular conflict", manuscripts published in English-language journals and indexed in PubMed between January 1, 2000 and June 1, 2013 on the treatment of trigeminal neuralgia (TN) with microvascular decompression were considered for this study. The success and complications were analyzed. The success in this investigation was defined as complete pain free. Continuous outcomes were summarized using means or medians, and dichotomous outcomes were presented as percentage associated with 95% confidence interval. Twenty-six papers with 6,847 patients were finally enrolled in this review. Among them, the male-to-female ratio was 1:1.4, the left-to-right ratio was 1:1.6, and the pain was located in the innervation of V3 and/or V2 in most of the cases with only 2.3% (0.1-4.7) of V1 exclusively. The average age at surgery was 60.9 years (52.5-64.1) with TN symptoms duration of 24.7 months (6.1-42.1) before microvascular decompression (MVD). Operative findings confirmed the superior cerebellar artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery, and multiple vascular contacts (including veins) as the most common sources of nerve compression. The average follow-up duration was 35.8 months (26.2-56.6). The success rate was 83.5% (79.6-89.1). Complications included incisional infection in 1.3% (0.1-2.5), facial palsy 2.9% (0.5-6.2), facial numbness 9.1% (1.3-19.6), cerebrospinal fluid leak 1.6% (0.7-2.5), and hearing deficit 1.9% (0.2-3.9). The postoperative mortality was 0.1% (0.02-0.2). Accordingly, MVD is the most effective treatment for patients with trigeminal neuralgia. An immediate pain free can be achieved by an experienced neurosurgeon with good knowledge of the regional anatomy. To avoid complications, each single step of the process cannot be overemphasized.

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Section: Discussioncontrasting

confidence: 65%

Effectiveness and Safety of Microvascular Decompression Surgery for Treatment of Trigeminal Neuralgia

Xia¹,

Zhong²,

Zhu³

et al. 2014

Journal of Craniofacial Surgery

109

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“…In the present study, the most frequent offending vessels were PICA and VB, as found in previous reports 4 13 16 26. However, several studies showed multiple sites of nerve compression at the origin of primary HFS 3 13 26.…”

Section: Discussionsupporting

confidence: 89%

“…Mooij et al 25 reported a similar experience of LSR disappearance after drainage of cerebrospinal fluid. In rare cases, the outflow of cerebrospinal fluid may consistently change the anatomical relationship between the facial nerve and a compressive vessel 11 12 19 26…”

Section: Discussionmentioning

confidence: 99%

A reappraisal of the value of lateral spread response monitoring in the treatment of hemifacial spasm by microvascular decompression

Neves

Lefaucheur

Andrade

et al. 2009

Journal of Neurology, Neurosurgery & Psychiatry

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“…Anatomic variations in vasculature such as lateral deviation of one or both vertebral arteries occurred on the ipsilateral side of HFS in 86.4% cases, making these variations a HFS risk factor [32]. The pattern of neurovascular compression can be divided into six different categories: (A) loop type, where the vascular itself creates the compression, (B) arachnoid type, where arachnoid trabeculae between the vessel and brainstem cause the vessel to tether to the nerve, (C) perforator type, where the perforating arteries from the compressing vessel tether the vessel to the brainstem, (D) branch type, where the nerve is caught between the compressing vessel and its branches, (E) sandwich type, where the nerve is sandwiched between two different vessels, and (F) tandem type, where one vessel compresses another vessel that compresses the nerve [33]. Multiple vessel compressions have been observed in 38% of HFS cases [23].…”

Section: Etiologymentioning

confidence: 99%

Hemifacial Spasm and Neurovascular Compression

Yeung

Gerrard

et al. 2014

The Scientific World Journal

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Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Its prevalence is 9.8 per 100,000 persons with an average age of onset of 44 years. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone of the facial nerve. HFS can be divided into two types: primary and secondary. Primary HFS is triggered by vascular compression whereas secondary HFS comprises all other causes of facial nerve damage. Clinical examination and imaging modalities such as electromyography (EMG) and magnetic resonance imaging (MRI) are useful to differentiate HFS from other facial movement disorders and for intraoperative planning. The standard medical management for HFS is botulinum neurotoxin (BoNT) injections, which provides low-risk but limited symptomatic relief. The only curative treatment for HFS is microvascular decompression (MVD), a surgical intervention that provides lasting symptomatic relief by reducing compression of the facial nerve root. With a low rate of complications such as hearing loss, MVD remains the treatment of choice for HFS patients as intraoperative technique and monitoring continue to improve.

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Hemifacial spasm: neurovascular compressive patterns and surgical significance

Abstract: Once the compressing vessel responsible for the neurovascular compression are identified, the probable pattern of compression can be anticipated; this knowledge could facilitate the application of the appropriate operative procedures and minimise post-operative complications.

Cited by 76 publications

References 25 publications

Effectiveness and Safety of Microvascular Decompression Surgery for Treatment of Trigeminal Neuralgia

Effectiveness and Safety of Microvascular Decompression Surgery for Treatment of Trigeminal Neuralgia

A reappraisal of the value of lateral spread response monitoring in the treatment of hemifacial spasm by microvascular decompression

Hemifacial Spasm and Neurovascular Compression

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