The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm

Abstract

Objective: Microvascular decompression (MVD) surgery has been accepted as a minimally invasive surgical modality for the treatment of hemifacial spasm (HFS). However, the size of the bone window does not match the concept of minimally invasive. This study is aimed at evaluating the efficacy and safety of &amp;lt;2 cm micro-keyhole MVD.Methods: A total of 148 patients with HFS diagnosed in the First Affiliated Hospital of Chongqing Medical University from January 1, 2019, to July 1, 2020, who underwent MVD in the neurosurgery department of the hospital were collected. Surgery was performed by a retrosigmoid keyhole approach with the bone hole diameter &amp;lt;2 cm, which was named micro-keyhole MVD. The efficacy and safety of the micro-keyhole MVD were evaluated by statistical analysis of the efficacy of the micro-keyhole MVD and the incidence of postoperative complications.Results: The effect of micro-keyhole MVD was satisfying (cure or partial remission) in 97.2% (n = 144). The failure and recurrence rates were 2.7% (n = 4) and 0.6% (n = 1), respectively. Among them, immediate facial palsy, delayed facial palsy, hearing loss, and cerebrospinal fluid (CSF) leakage were found in 0.6% (n = 1), 8.1% (n = 12), 4.7% (n = 7), and 1.3% (n = 2). Only one patient developed cerebellar infarction, which was complicated by “moyamoya disease.” The micro-keyhole MVD in the treatment of HFS can achieve a high remission rate and reduce the incidence of surgical complications.Conclusion: Micro-keyhole MVD is a safe and effective minimally invasive treatment for HFS. This technique does not increase the incidence of cranial nerve injury. Meanwhile, it reduces the incidence of CSF leakage and hearing loss (HL).

Autologous bone fragments for skull reconstruction after microvascular decompression

“…With the advancement of microneurosurgical techniques, the size of the bone window required for MVD surgery is gradually decreasing. Studies have reported that a small bone window of about 2 cm is adequate for MVD surgery and obtains the same surgical outcomes as a large bone window [18,19]. In some institutions, a small bone flap is milled out with a milling tool and fixed with a connecting piece; in others, the bone window is enlarged with a rongeurs and repaired postoperatively with titanium mesh or other artificial bone repair material.…”

Factors Associated With Post-craniotomy Headache After Microvascular Decompression in Hemifacial Spasm

“…All patients were routinely examined by magnetic resonance imaging (MRI)to exclude posterior fossa tumors. The surgical method has been described in detail in our previous research (Huang, Zhan et al 2021). What needs a special explanation is that we used a <2 cm micro-Keyhole to complete the operation.…”