No abstract available.
Microvascular Decompression Surgery*

Humans ; Microvascular Decompression Surgery ; Neuralgia ; surgery

OBJECTIVE

To report the demographics, clinical characteristics, and surgical outcomes after microvascular decompression (MVD) for hemifacial spasm (HFS) in the Philippine General Hospital (PGH).

Between January 2018 to December 2022, the division of Neurosurgery at PGH performed thirty-four MVD operations for Primary HFS. Records were retrospectively reviewed, and pertinent demographic, intra-operative findings, outcomes, and complications were analyzed.

The overall success rate is 88.2%, with a median follow-up at 15 months. Repeated measures ANOVA showed that post-op HFS and follow-up HFS grades were significantly lower than pre-op HFS grades (F=17.46, df=33, p < 0.0001). HFS average age of symptom onset was early at 38.5 years, 11.8% of which wereCONCLUSION

MVD at PGH is a viable choice treatment option for Filipino patients with success rates comparable to internationally published studies. Besides improving surgical technique, improvement of referral systems may help make surgery more accessible.

OBJECTIVE: The microvascular decompression(MVD) for trigeminal neuralgia(TN) is known as an effective surgical technique. But the failed MVD cases have been reported in long term follow-up studies. This study is to evaluate the efficacy of MVD through our operative techniques, offending vessels in operative field, failed cases with the review of the literatures. METHODS: We analyzed total 63 cases of TN which underwent MVD from 1955 to 2003 according to characters of pain, operative findings, operative results related to causative vessel compression and operative method, progonotic factor. Statistical analysis was performed using paired t-test with SPSS Ver 11.0. RESULTS: In TN, the most common offending vessel was superior cerebellar artery(45.0%). In compression group of nerve root by offending vessel, the cure rate was 91.7%. However, the cure rate of the contact group was 64.7% and the cure rate of the negative group was 37.5%. There was no statistical significance between the degree of compression by vessel and the operative result(p=0.076). In 51 cases with MVD only, the cure rate was 84.3% and in 3 cases with PSR only, 42.8% and in 2 cases with PSR(partial sensory rhizotomy) with MVD, 50.0%. TN recurred in 7 cases within the follow-up period and reoperations(PSR) were added in 2 cases of them. CONCLUSION: This study shows that MVD provided a high rate of success with a minor risk of complications, which has been regarded as the most safe and effective procedure for trigeminal neuralgia. Additional MVD in recurred TN by severe adhesion of teflon showed poor outcome. But, revisional operation(PSR) in recurred TN showed relatively good outcome. PSR should be considered for treatment of recurrent TN after MVD.
Follow-Up Studies ; Microvascular Decompression Surgery* ; Polytetrafluoroethylene ; Trigeminal Neuralgia*

OBJECTIVE: Gamma knife radiosurgery (GKRS) is the least invasive surgical option for patients with trigeminal neuralgia (TN). However, the indications and long term outcomes of GKRS are still controversial. Additionally, a series with uniform long-term follow-up data for all patients has been lacking. In the present study, the authors analyzed long-term outcomes in a series of patients with TN who underwent a single GKRS treatment followed by a minimum follow-up of 60 months. METHODS: From 1994 to 2009, 40 consecutive patients with typical, intractable TN received GKRS. Among these, 22 patients were followed for >60 months. The mean maximum radiation dose was 77.1 Gy (65.2-83.6 Gy), and the 4 mm collimator was used to target the radiation to the root entry zone. RESULTS: The mean age was 61.5 years (25-84 years). The mean follow-up period was 92.2 months (60-144 months). According to the pain intensity scale in the last follow-up, 6 cases were grades I-II (pain-free with or without medication; 27.3%) and 7 cases were grade IV-V (<50% pain relief with medication or no pain relief; 31.8%). There was 1 case (facial dysesthesia) with post-operative complications (4.54%). CONCLUSION: The long-term results of GKRS for TN are not as satisfactory as those of microvascular decompression and other conventional modalities, but GKRS is a safe, effective and minimally invasive technique which might be considered a first-line therapy for a limited group of patients for whom a more invasive kind of treatment is unsuitable.
Follow-Up Studies ; Humans ; Microvascular Decompression Surgery ; Radiosurgery ; Trigeminal Neuralgia

No abstract available.
Arachnoid* ; Cranial Nerves* ; Facial Nerve* ; Microvascular Decompression Surgery*

The authors present a case of isolated dural arteriovenous fistula (DAVF) in the transverse sinus, which developed six years after microvascular decompression caused by hemifacial spasm via suboccipital craniectomy. The lesion was successfully treated by transarterial embolization using Onyx. We reviewed the related radiologic and therapeutic features of DAVF involving an isolated sinus and described the feasibility of the use of Onyx.
Central Nervous System Vascular Malformations ; Hemifacial Spasm ; Microvascular Decompression Surgery

A case of spasmodic torticollis in a 48-year-old man cured by micovascular decompression of the spinal accessory nerve with selective dorsal cervical rhizotomy of the first and second cervical nerves. The 11th nerve was compressed by the posterior inferior cerebellar artery originating from the vertebral artery at the C1 level. After intraoperative identification of each posterior rootlets of C1 and C2 nerves exclusively related with the involved sternocleidomastoid muscle(SCM) using the monopolar electric nerve stimulator, microvascular decompression with selective dorsal cervical rhizotomy was done using the Teflon felt and electrobipolar coagulator. The patient was significantly relieved from symptoms 1 week after operation.
Accessory Nerve ; Arteries ; Decompression ; Humans ; Microvascular Decompression Surgery* ; Middle Aged ; Polytetrafluoroethylene ; Rhizotomy ; Torticollis* ; Vertebral Artery

The result of microvascular decompression(MVD) in 105 consecutive cases is presented. The symptomatic vasculoneural compressions including tumor, vascular malformation, or aneurysm are excluded in this study group. The 41 patients with trigeminal neuralgia(TN) were all treated by posterior fossa exploration(PEE). Eighteen of them were treated with MVD only, another 14 with partial sensory rhizotomy(PSR) only, and in the other 9 patients, MVD and PSR were performed together. Sixty-twp of 64 hemifacial spasm(HFS) cases were treated succesfully with MVD via PFE. However in one case of which the offending vessel was not identified, neurolysis was carried out. The other case who had both TN and HFS, died due to intraoperative cardiac arrest. The result of operation was evaluated at one month after the operation. In TN, among thirty-nine(98%) patients who resulted in pain-improvement, 32(82%) experienced complete resolution of the pain, The rate complete pain-relief was higher in the 'MVD only group' than in 'group with PSR'. Among 62(94%) cases of HFS, 29(47%) patients obtained 'complete cure' and 'improvement-only' respectively ; only 4(6%) patients had no change of the spasm. The preoperative clinical characteristics, intraoperative surgical findings and postoperative outcomes were itemized and analyzed find out the prognostic factors. The our results are compared with others in the literature.
Aneurysm ; Decompression* ; Heart Arrest ; Hemifacial Spasm* ; Humans ; Microvascular Decompression Surgery ; Spasm ; Trigeminal Neuralgia* ; Vascular Malformations

OBJECTIVE: The aim of this study is to evaluate of the significance of intraoperative electrophysiologic monitoring and follow up electrophysiologic study at seven days after microvascular decompression(MVD) for hemifacial spasm(HFS). METHODS: Thirty nine patients with hemifacial spasm were included in this study and were treated with MVD of the facial nerve from Jun 1990 to May 2001. The patients were divided into a monitoring group and a non-monitoring group. We compared the surgical outcomes, operation related complications between two groups. The abnormal muscle response(AMR) of preoperative electromyographic recording appeared on the mentalis muscle during stimulation of the zygomatic branch of the facial nerve was compared with those of changed during operation, immediately after operation and at postoperative 7th day(POD 7). The relationship between degree of AMR disappearance and surgical outcome was analyzed. RESULTS: There was no difference in surgical outcomes but significant difference in the incidence of operation-related complications between two groups. The results of electrophysiologic study at POD 7 were significantly correlated with surgical outcome in the monitoring group. CONCLUSION: The electrophysiologic study is helpful for identifying the offenders, determining the adequacy of vascular decompression and decrease of operation-related complications. The clinical and electrophysiologic status of HFS after MVD has continuously changed, and therefore the results of eletrophysiologic study at POD 7 are useful for predicting the surgical outcome.
Criminals ; Decompression ; Electromyography* ; Facial Nerve ; Follow-Up Studies* ; Hemifacial Spasm* ; Humans ; Incidence ; Microvascular Decompression Surgery*