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.

Hemifacial Spasm/surgery* ; Humans ; Microvascular Decompression Surgery ; Philosophy ; Postoperative Complications ; Treatment Outcome

Objective To evaluate the effect of methylprednisolone sodium succinate combined with tropisetron on postoperative nausea and vomiting(PONV)under microvascular decompression of hemifacial spasm.Methods From January to June 2019,485 patients undergoing microvascular decompression for facial spasm at Department of Neurosurgery,Peking University People's Hospital were randomly assigned into two groups with random number table method.For group A(n=242),2 ml saline was administrated by intravenous drip before induction and 5 mg tropisetron after operation.For group B(n=243),40 mg methylprednisolone sodium succinate was administrated by intravenous drip before induction and 5 mg tropisetron after operation.The anesthesia time,operation time,and incidence of PONV in 0-24 h and 24-48 h were recorded for the comparison of the remedial treatment rate of nausea and vomiting between the two groups.Results There was no significant difference in age,gender,smoking history,body mass index value,American Society of Anesthesiologists score,medical history,surgical side,PONV history,operation time or anesthesia time between the two groups(all P > 0.05).The incidence of PONV in group A was 35.5% and 18.2% during 0-24 h and 24-48 h,respectively,which was significantly higher than that(18.5%,χ
Antiemetics ; Double-Blind Method ; Hemifacial Spasm/surgery* ; Humans ; Indoles ; Methylprednisolone Hemisuccinate/therapeutic use* ; Microvascular Decompression Surgery ; Tropisetron

Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.
Decompression ; Electromyography ; Evoked Potentials, Auditory, Brain Stem ; Evoked Potentials, Motor ; Facial Nerve ; Hemifacial Spasm ; Intraoperative Neurophysiological Monitoring ; Microvascular Decompression Surgery ; Vestibulocochlear Nerve

BACKGROUND AND PURPOSE: Hemifacial spasm (HFS) is mostly caused by the compression of the facial nerve by cerebral vessels, but the significance of spasm severity remains unclear. We investigated the clinical significance of spasm severity in patients with HFS who underwent microvascular decompression (MVD). METHODS: We enrolled 636 patients with HFS who underwent MVD between May 2010 and December 2013 at Samsung Medical Center (SMC), Seoul, Korea. Subjects were divided into two groups based on spasm severity: severe (SMC grade 3 or 4) and mild (SMC grade 1 or 2). We compared demographic, clinical, and surgical data between these two groups. RESULTS: The severe-spasm group was older and had a longer disease duration at the time of MVD compared to the mild-spasm group. Additionally, hypertension and diabetes mellitus were more common in the severe-spasm group than in the mild-spasm group. Regarding surgical findings, there were more patients with multiple offending vessels and more-severe indentations in the severe-spasm group than in the mild-spasm group. Even though the surgical outcomes did not differ, the incidence of delayed facial palsy after MVD was higher in the severe-spasm group than in the mild-spasm group. Logistic regression analysis showed that severe-spasm was correlated with longer disease duration, hypertension, severe indentation, multiple offending vessels, and delayed facial palsy after MVD. CONCLUSIONS: Spasm severity does not predict surgical outcomes, but it can be used as a marker of pathologic compression in MVD for HFS, and be considered as a predictor of delayed facial palsy after MVD.
Diabetes Mellitus ; Facial Nerve ; Facial Paralysis* ; Hemifacial Spasm* ; Humans ; Hypertension ; Incidence ; Korea ; Logistic Models ; Microvascular Decompression Surgery ; Seoul ; Spasm

OBJECTIVE: Microvascular decompression (MVD) for hemifacial spasm (HFS) involving the vertebral artery (VA) can be technically challenging. We investigated the therapeutic effects of a bioglue-coated Teflon sling technique on the VA during MVD in 42 cases. METHODS: A bioglue-coated Teflon sling was crafted by the surgeon and applied to patients in whom neurovascular compression was caused by the VA. The radiologic data, intra-operative findings with detailed introduction of the procedure, and the clinical outcomes of each patient were reviewed and analyzed. RESULTS: The 42 patients included in the analysis consisted of 22 females and 20 males, with an average follow-up duration of 76 months (range 24–132 months). Intraoperative investigation revealed that an artery other than the VA was responsible for the neurovascular compression in all cases : posterior inferior cerebellar artery (PICA) in 23 patients (54.7%) and anterior inferior cerebellar artery (AICA) in 11 patients (26.2%). All patients became symptom-free after MVD. Neither recurrence nor postoperative neurological deficit was noted during the 2-year follow-up, except in one patient who developed permanent deafness. Cerebrospinal fluid (CSF) leak occurred in three patients, and one required dural repair. CONCLUSION: Transposition of the VA using a bioglue-coated Teflon sling is a safe and effective surgical technique for HFS involving the VA. A future prospective study to compare clinical outcomes between groups with and without use of this novel technique is required.
Arteries ; Cerebrospinal Fluid ; Deafness ; Female ; Follow-Up Studies ; Hemifacial Spasm* ; Humans ; Male ; Microvascular Decompression Surgery* ; Polytetrafluoroethylene* ; Prospective Studies ; Recurrence ; Therapeutic Uses ; Vertebral Artery*

Tinnitus had been considered a surgically incurable disease, given the failure of several treatment methods. Jannetta reported that tinnitus is one of the hyperactive diseases of the cranial nerve along with hemifacial spasm and trigeminal neuralgia (TGN). Microvascular decompression (MVD) of the eighth cranial nerve was introduced to treat medically intractable tinnitus. Intraoperative monitoring of brainstem auditory evoked potential (BAEP) was able to reduce postoperative complication rates. Less than 1 ms of latency delay and a 40% decrease in amplitude of wave V of the brainstem evoked potential is a landmark of monitoring during surgery. Less than 6 years of duration of tinnitus, normal BAEP before surgery, no accompanying dizziness before surgery and a loop-type offending artery are effective factors for good surgical results of MVD.
Arteries ; Brain Stem ; Cranial Nerves ; Dizziness ; Evoked Potentials ; Evoked Potentials, Auditory, Brain Stem ; Hemifacial Spasm ; Microvascular Decompression Surgery* ; Monitoring, Intraoperative ; Postoperative Complications ; Tinnitus* ; Trigeminal Neuralgia ; Vestibulocochlear Nerve

A 61-year-old female presented with 4 years history of left-sided hemifacial spasm. Head MRI and angiography indicated left vertebral artery dissecting aneurysm which compressed ipsilateral cranial nerves Ⅶ and Ⅷ. Microvascular decompression was performed. The dissecting aneurysm was pushed apart and the distal part of the parent artery was adhered to the dura on the petrosum. The compressed nerves were totally decompressed. The symptom of facial spasm was completely resolved immediately after surgery and did not recur during 6 months of follow up.
Cerebral Angiography ; Facial Nerve ; pathology ; Female ; Hemifacial Spasm ; surgery ; Humans ; Magnetic Resonance Imaging ; Microvascular Decompression Surgery ; Middle Aged ; Nerve Compression Syndromes ; diagnosis ; etiology ; surgery ; Vertebral Artery Dissection ; diagnostic imaging ; surgery ; Vestibulocochlear Nerve ; pathology

Hemifacial spasm (HFS) is a clinical syndrome characterized by unilateral facial nerve dysfunction. The usual cause involves vascular compression of the seventh cranial nerve, but compression by an artery passing through the facial nerve is very unusual. A 20-year-old man presented with left facial spasm that had persisted for 4 years. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery (AICA) was revealed on magnetic resonance angiography. During microvascular decompression surgery, penetration of the distal portion of the facial nerve root exit zone by the AICA was observed. At the penetrating site, the artery was found to have compressed the facial nerve and to be immobilized. The penetrated seventh cranial nerve was longitudinally split about 2 mm. The compressing artery was moved away from the penetrating site and the decompression was secured by inserting Teflon at the operative site. Although the facial spasm disappeared in the immediate postoperative period, the patient continued to show moderate facial weakness. At postoperative 12 months, the facial weakness had improved to a mild degree. Prior to performing microvascular decompression of HFS, surgeons should be aware of a possibility for rare complex anatomy, such as compression by an artery passing through the facial nerve, which cannot be observed by modern imaging techniques.
Arteries* ; Decompression ; Facial Nerve* ; Hemifacial Spasm* ; Humans ; Magnetic Resonance Angiography ; Microvascular Decompression Surgery ; Polytetrafluoroethylene ; Postoperative Period ; Spasm ; Young Adult

Dural arteriovenous fistula (AVF) is very rare, acquired lesion that may present with intracranial hemorrhage or neurological deficits. The etiology is not completely understood but dural AVF often has been associated with thrombosis of the involved dural sinuses. To our knowledge, this is the first well documented intracranial hemorrhage case caused by dural AVF following microvascular decompression for hemifacial spasm. A 49-year-old male patient had left microvascular decompression of anterior inferior cerebellar artery via retrosigmoid suboccipital craniotomy. The patient was in good condition without any residual spasm or surgery-related complications. However, after 10 months, he suffered sudden onset of amnesia and dysarthria. Computed tomography and magnetic resonance imaging revealed the presence of dural AVF around the left transverse-sigmoid sinus. The dural AVF was treated with Onyx(R) (ev3) embolization. At the one-year follow up visit, there were no evidence of recurrence and morbidity related to dural AVF and its treatment. This case confirms that the acquired etiology of dural AVF may be associated with retrosigmoid suboccipital craniotomy for hemifacial spasm, even though it is an extremely consequence of this procedure.
Amnesia ; Arteries ; Central Nervous System Vascular Malformations* ; Craniotomy ; Dysarthria ; Follow-Up Studies ; Hemifacial Spasm* ; Humans ; Intracranial Hemorrhages ; Magnetic Resonance Imaging ; Male ; Microvascular Decompression Surgery* ; Middle Aged ; Recurrence ; Spasm ; Thrombosis