• Ning-Ning Dou, Jun Zhong, Ming-Xing Liu, Lei Xia, Hui Sun, Bin Li, and Shi-Ting Li.
• Department of Neurosurgery, Xin Hua Hospital, Cranial Nerve Disease Center of Shanghai, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
• Stereotact Funct Neurosurg. 2016 Jan 1; 94 (3): 154-8.

BackgroundAlthough Teflon is widely adopted for microvascular decompression (MVD) surgery, it has never been addressed for failure analysis. This study analyzed the reasons for failed MVDs with emphasis on the Teflon sponge.MethodsAmong the 685 hemifacial spasm cases between 2010 and 2014, 31 were reoperated on within a week because of unsatisfactory outcome, which was focused on in this study. Intraoperative findings regarding Teflon inserts of these repeat MVDs were reviewed.ResultsAmong the 38 without satisfactory outcomes, 31 underwent repeat MVDs, and they were all spasm free afterwards. Eventually, the final cure rate was 99.2%. It was found in the repeat MVDs that the failure was attributable to the Teflon insert in most of the cases (74.2%) directly or indirectly. It was caused by improper placement (47.8%), inappropriate size (34.8%) and unsuitable shape (17.4%) of the Teflon sponge.ConclusionAlthough it is not difficult for an experienced neurosurgeon to discover a neurovascular conflict during the MVD process, the size, shape and location of the Teflon sponge should not be ignored. Basically, the Teflon insert is used to keep the offending artery away from the facial nerve root rather than to isolate it. Therefore, the ideal Teflon sponge should be just small enough to produce a neurovascular separation.© 2016 S. Karger AG, Basel.

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