• Seunghoon Lee, Sang-Ku Park, Byung-Euk Joo, Jeong-A Lee, and Kwan Park.
• Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
• World Neurosurg. 2019 Oct 1; 130: e577-e582.

BackgroundVascular complications in posterior fossa surgery, even in microvascular decompression (MVD) involving a small cranial opening, can have catastrophic consequences. We analyzed these complications to determine the incidence, risk factors, prognosis, and preventive measures involved.MethodsBetween April 1997 and March 2018, 4000 consecutive patients with neurovascular compression syndrome were admitted and underwent MVD. We reviewed the medical records of patients who developed vascular complications after MVD, focusing on their past medical history, perioperative laboratory findings and images, surgical findings, and postoperative progress.ResultsVascular complications developed in 28 patients (0.7%), including 24 with hemifacial spasm and 4 with trigeminal neuralgia. Twenty-two hemorrhagic (78.6%) and 6 ischemic (21.4%) complications occurred, with epidural hematoma the most frequent type identified. Ten patients (35.7%) patients were asymptomatic and 18 (64.3%) were symptomatic. Six patients (21.4%) underwent revision surgery, such as hematoma removal, craniectomy, or extraventricular drainage insertion. At the last follow-up, dizziness was the most commonly reported sequela from vascular complications. No deaths had occurred.ConclusionsVascular complications are rare, but can be the most devastating adverse outcome of MVD surgery. Unusual signs and symptoms after MVD should prompt special attention to early management and patient safety.Copyright © 2019 Elsevier Inc. All rights reserved.

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