Microvascular decompression of cranial nerves: lessons learned after 4400 operations

McLaughlin, Mark R.; Jannetta, Peter J.; Clyde, Brent L.; Subach, Brian R.; Comey, Christopher H.; Resnick, Daniel K.

doi:10.3171/jns.1999.90.1.0001

Cited by 603 publications

(159 citation statements)

References 11 publications

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“…In table 3, we compared the clinical results of our patients with previously reported results of DFP patients who underwent MVD for HFS. Although facial spasm completely disappeared after MVD, delayed facial weakness may decrease the patient’s individual satisfaction [1,5,7,38,39,40]. With delayed facial weakness after surgery, relevant explanations have been introduced including reactivation of HSV, delayed facial nerve edema due to unwanted inflammation, and microcirculation disruptions due to an ischemic result.…”

Section: Discussionmentioning

confidence: 99%

“…Hemifacial spasm (HFS) is a functional disorder characterized by twitching of the muscles innervated by the facial nerve. MVD is a highly accepted and effective method for the treatment of patients with HFS with an operative morbidity of less than 10% [5,6,7,8]. The risks of the operation are generally related to the surgical approach and particularly to surgery on the seventh nerve [2].…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Facial Electromyography and Brainstem Auditory Evoked Potential Findings in Microvascular Decompression for Hemifacial Spasm: Correlation with Postoperative Delayed Facial Palsy

Kim

Park

Ryu³

et al. 2012

Stereotact Funct Neurosurg

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Background: Delayed facial palsy (DFP) after microvascular decompression (MVD) in patients with hemifacial spasm (HFS) is not uncommon, but the cause remains unknown. Objectives: To assess whether intraoperative electromyography (EMG) and brainstem auditory evoked potential (BAEP) can predict DFP after MVD. Methods: Between September 2009 and February 2011 we examined 86 patients, 9 of whom (10.4%) developed DFP after MVD on the same side. All patients underwent MVD and were followed-up for a median period of 13 months (range 6–22). We retrospectively examined intraoperative facial EMG and BAEP findings using our MVD patients’ registry. We excluded secondary HFS and immediate postoperative facial palsy after MVD in this study. We assessed the prevalence and clinical characteristics of DFP and compared EMG and BAEP findings between DFP and non-DFP groups. Results: All patients recovered completely, with a mean time to recovery of 37.8 days (range 22–57). There were no significant differences between DFP and non-DFP patients in terms of the amplitude and latency of intraoperative EMG and BAEP. Conclusion: The usefulness of intraoperative facial EMG and BAEP is limited and cannot predict DFP after MVD for HFS. We speculate that DFP after MVD is not associated with permanent nerve damage according to the EMG findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intraoperative Facial Electromyography and Brainstem Auditory Evoked Potential Findings in Microvascular Decompression for Hemifacial Spasm: Correlation with Postoperative Delayed Facial Palsy

Kim

Park

Ryu³

et al. 2012

Stereotact Funct Neurosurg

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“…material, see www.karger.com?doi=10.1159/000342795), the patient’s head is secured in a Mayfield 3-pin head clamp. We use the Mayfield clamp technique and positioning described by McLaughlin et al [22]. The following landmarks should be noted prior to prepping: the tip of the mastoid process, the insertion of the digastric muscle, and the course of the sigmoid and transverse sinus as described by McLaughlin et al [22] (fig.…”

Section: Surgical Techniquementioning

confidence: 99%

Endoscopic Microvascular Decompression: A Stepwise Operative Technique

Lang

Chen²,

Lee³

2012

ORL

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Background/Aims: Microvascular decompression (MVD) of the trigeminal nerve is a widely accepted treatment for patients with trigeminal neuralgia caused by vascular compression. The neuroendoscope is rapidly becoming a complementary tool in minimally invasive neurosurgery of the ventral anterior skull base. Its adoption in the lateral approach to the posterior fossa has been slower and has been used primarily as an adjunct to conventional microscopic surgical techniques, e.g. endoscope-assisted microsurgery. Methods: In this paper, we describe a stepwise, technical commentary on a purely endoscopic MVD of the trigeminal nerve via the retrosigmoid route. Results: From our experience, the endoscope provides excellent visualization of the neurovascular relationship. By allowing full visualization of the trigeminal nerve, endoscopy may likely lead to an increase in the number of successful MVDs and a decrease in the number of complications. Conclusion: We believe endoscopic MVD is a safe and effective method of accessing the trigeminal nerve in the cerebellopontine angle and of performing MVD. This endoscopic technique can be implemented in other neurosurgical and neuro-otological procedures such as resection of cerebellopontine angle masses.

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“…In the study by Defazio et al [7], 70 of 86 patients continued botulinum toxin injections and 2 (2.3%) experienced complete and long-lasting relief of symptoms. In cases of patients treated with MVD, many researchers report a success rate of approximately 85-95% postoperatively [1,8,10,12]. In other words, this means 5-15% of MVD patients experience remission.…”

Section: Introductionmentioning

confidence: 99%

“…Most studies have found treatment with medications unsatisfactory [3,5]. On the other hand, many studies have established the efficacy of botulinum toxin therapy or microvascular decompression (MVD) in the treatment of HFS [3,4,5,6,7,8,9,10,11,12,13,14]. …”

Section: Introductionmentioning

confidence: 99%

Natural History of Untreated Hemifacial Spasm: A Study of 104 Consecutive Patients over 5 Years

Lee

Kim²,

Park³

2017

Stereotact Funct Neurosurg

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Background: The natural history without treatment of a large series of hemifacial spasm (HFS) patients has not been well-documented. Objective: The purpose of this study was to characterize the natural history and clinical outcome in patients with HFS. Methods: The initial visits of all 2,155 patients and the diagnosis of HFS took place between 2001 and 2010. In 1,775 of the patients, compressing vessels were identified on magnetic resonance imaging. Of these, we excluded 1,469 patients (82.8%) who received microvascular decompression, 101 (5.7%) who continued to visit the clinic for botulinum toxin injections, and 9 (0.5%) who died or suffered from other diseases. Ninety-two (5.2%) of the patients were lost to follow-up; the remaining 104 were followed up for 5-42 years (mean 12 years) after the onset of the symptoms of HFS. Results: The condition was aggravated in 11 (10.6%) of the 104 patients and stationary in 40 (38.5%) for 6-42 years (mean 13 years). Ten (9.6%) improved partially for 7-18 years (mean 11 years). Forty-three (41.3%) were in remission for between 2 months and 23 years (mean 6.4 years) after onset and required no further treatment for 5 months to 13 years (mean 5.7 years). Conclusion: This study provides useful information to HFS patients for understanding the disease and determining treatment.

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Microvascular decompression of cranial nerves: lessons learned after 4400 operations

Abstract: Using the techniques described in this report, microvascular decompression is an extremely safe and effective treatment for many cranial nerve rhizopathies.

Cited by 603 publications

References 11 publications

Intraoperative Facial Electromyography and Brainstem Auditory Evoked Potential Findings in Microvascular Decompression for Hemifacial Spasm: Correlation with Postoperative Delayed Facial Palsy

Intraoperative Facial Electromyography and Brainstem Auditory Evoked Potential Findings in Microvascular Decompression for Hemifacial Spasm: Correlation with Postoperative Delayed Facial Palsy

Endoscopic Microvascular Decompression: A Stepwise Operative Technique

Natural History of Untreated Hemifacial Spasm: A Study of 104 Consecutive Patients over 5 Years

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