Articles: microvascular-decompression-surgery.
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Bilateral hemifacial spasm (HFS) is very rare. The literature contains only 32 clinical reports. Although microvascular decompression (MVD) is widely accepted as effective therapy for HFS, the etiology and surgical treatment of bilateral HFS are seldom addressed. We report our experience with MVD for patients with bilateral HFS. ⋯ Vascular compression was the cause of bilateral HFS in our patients, and MVD relieved the symptoms. Thus, we recommend MVD for patients with bilateral HFS. A crowded cerebellopontine angle space and easy attrition of the neurovascular interfaces may play important roles in the occurrence of bilateral HFS. For some patients, 1 MVD can resolve bilateral symptoms.
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Journal of neurosurgery · Feb 2016
Microvascular decompression for atypical hemifacial spasm: lessons learned from a retrospective study of 12 cases.
Typical hemifacial spasm (HFS) commonly initiates from the orbicularis oculi muscle to the orbicularis oris muscle. Atypical HFS (AHFS) is different from typical HFS, in which the spasm of muscular orbicularis oris is the primary presenting symptom. The objective of this study was to analyze the sites of compression and the effectiveness of microvascular decompression (MVD) for AHFS. ⋯ The authors conclude that most cases of AHFS were caused by neurovascular compression on the posterior/rostral side of the facial nerve distal to the root entry zones. MVD is a safe treatment for AHFS, but the incidence of postoperative complications, such as facial paralysis and decrease in hearing, remains high.
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Journal of neurosurgery · Jan 2016
Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations.
OBJECT Microvascular decompression (MVD) surgery for hemifacial spasm (HFS) is potentially curative. The findings at repeat MVD in patients with persistent or recurrent HFS were analyzed with the aim to identify factors that may improve surgical outcomes. METHODS Intraoperative findings were determined from review of dictated operative reports and operative diagrams for patients who underwent repeat MVD after prior surgery elsewhere. ⋯ Significant factors that may have contributed to the failure of the first surgery included retromastoid craniectomies that did not extend laterally to the sigmoid sinus or inferiorly to the posterior fossa floor in 11 of 12 patients and a prior surgical approach that focused on the cisternal portion of the facial nerve in 9 of 12 patients. In all cases, significant persistent neurovascular compression (NVC) was evident and alleviated more proximally on the facial root exit zone (fREZ). CONCLUSIONS Most HFS patients will achieve spasm relief with thorough alleviation of NVC of the fREZ, which extends from the pontomedullary sulcus root exit point to the Obersteiner-Redlich transition zone.
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Case Reports
Microvascular decompression of the optic nerve for paroxysmal phosphenes and visual field deficit.
Microvascular decompression surgery is standard neurosurgical practice for treating trigeminal neuralgia and hemifacial spasm. Most other cranial nerves have been decompressed for paroxysmal intermittent hyperactivity of the affected cranial nerve or in very long-standing compressions to treat cranial nerve hypofunctioning. ⋯ This case report adds to the few previous case reports combining 2 previously described techniques (i.e., microvascular decompression and anterior clinoidectomy plus optic canal unroofing).
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Stereotact Funct Neurosurg · Jan 2016
Teflon Might Be a Factor Accounting for a Failed Microvascular Decompression in Hemifacial Spasm: A Technical Note.
Although 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. ⋯ Although 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.