Articles: microvascular-decompression-surgery.
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Hemifacial spasm is a cranial nerve compression syndrome caused by impingement on the facial nerve most frequently by the anterior inferior cerebellar artery or the posterior inferior cerebellar artery. It can be treated with microvascular decompression (MVD) to separate the nerve from the offending artery. Rarely, a large-caliber vessel such as a dolichoectatic vertebrobasilar system may be implicated, requiring more than an MVD. ⋯ Following sling placement and MVD, neuromonitoring demonstrated absence of abnormal motor responses. Postoperative course was uneventful, she remained neurologically intact, and she remained free of symptoms at 6 months' follow-up. This video highlights the decision making for selecting the appropriate case of hemifacial spasm for sling decompression, the key technical nuances, and complication avoidance in these challenging cases.
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Microvascular decompression (MVD) is the treatment of choice for hemifacial spasm (HFS), due to the high rate of complete resolution associated with MVD. However, some patients experience recurrent or persistent symptoms after surgery. In this study, we evaluated the causes of recurrence or failure based on our surgical experience with revision of MVD for HFS and analyzed the relationship between surgical outcomes and radiologic and intraoperative findings. ⋯ The decision regarding secondary MVD for persistent or recurrent spasm is troubling. However, if neurovascular contact was observed in the MRI of the patient and there were offending vessels, the surgical outcome might be favorable.
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Multicenter Study
Prosthesis used in microvascular decompressions: a multicenter survey in Japan focusing on adverse events.
To investigate the characteristics of materials used as prostheses for microvascular decompression surgery (MVDs) in Japan and their possible adverse events (AEs) to determine preferable materials for MVDs. ⋯ The number of AEs was quite low in this survey, and intradural use of any prosthesis reported in this paper might be justified; however, further development of easily handled and less-adhesive prosthesis materials is awaited.