HFS primarily attributed to neurovascular compression at the root exit zone (REZ) of the CNVII, presents significant challenges in diagnosis and management. While Microscopic MVD remains the gold standard treatment, its efficacy in cases involving vertebrobasilar dolichoectasia (VBD) is less explored. This systematic review aimed to evaluate the safety and efficacy of endoscopic-assisted MVD (E-MVD) specifically in HFS secondary to VBD.

Comprehensive search using MeSH key words “Endoscopic”, “Microvascular Decompression”, “Vertebral Artery”, “Hemifacial spasm” across multiple databases was done. Following PRISMA guidelines, we identified six eligible studies. Descriptive statistics were used, qualitative and quantitative data were numerically expressed. Crude odds ratios of certain characteristics that may be attributable to comorbidities/post-operative complications were also determined. These were performed with a 95% confidence interval, p-value of <0.05 will be considered statistically significant.

Mean age was 53.63 years with female predominance. E-MVD demonstrated an 84.06% complete resolution rate, with partial resolution in 8.70% and no relief in 7.25% of cases. Transient facial palsy was the primary postoperative complication. Following factors pose increased risk for comorbidities/post-operative complications: age ≥ 60 years old (4.2500), male (1.1905), AICA involvement (3.7037) and left sided involvement (1.5750).

Comparison with traditional microscopic MVD reveals comparable success rates, with E-MVD offering enhanced visualization and potential reductions in complications. Challenges related to vertebral artery involvement and complex compression patterns are addressed more effectively with endoscopic techniques. While the learning curve for surgeons transitioning to endoscopic approaches exists, the benefits of minimally invasive procedures warrant further exploration and adoption.

Human ; Hemifacial Spasm ; Microvascular Decompression Surgery ; Vertebrobasilar Insufficiency ; Vertebral Artery ; Confidence Intervals ; Odds Ratio

Introduction: Skull base metastasis from follicular thyroid carcinoma (FTC) is uncommon, with an incidence of 2.5%. Presented here is a case of a 63-year-old female presenting with a 2-year history of progressive left eye proptosis, with a previous history of thyroid surgery for non-toxic goiter. Imaging findings were uncharacteristic of any common skull base tumor. Biopsy revealed follicular thyroid carcinoma. The authors used this case as basis and performed an analysis on available literature for FTC skull base metastasis to help guide management of future cases. Methods: Using PRISMA guidelines, a systematic search across PubMed, Google Scholar, and Cochrane Library using MeSH keywords “Skull base,” “Metastasis,” and “Follicular Thyroid Carcinoma,” identified 18 records. After screening, 15 articles assessed for eligibility, with 8 studies meeting inclusion criteria for qualitative analysis. Results: Studies showcased a consistent age range (43 to 69 years) among patients diagnosed with FTC. Presentation varied depending on tumor location, with symptoms such as dysphagia, proptosis, epistaxis, facial dysesthesia, and visual impairment. Tumor size ranged from 3cm x 3cm x 2cm to 6.8cm x 3.9cm x 5.3cm, influencing management strategies ranging from simple biopsy to sub-temporal complete excision. Adjuvant therapies included combinations of intensity-modulated radiation therapy (IMRT) with immunotherapy, multiple courses of I-131 therapy, oral radioiodine ablation, and radiotherapy, with outcomes showing improvement in most cases. Follow-up duration varied from 12 to 60 months. Conclusion FTC skull base metastasis remains to be an uncommon entity in neurosurgery. Its rarity creates a lack of established guidelines and treatment algorithms. A high index of suspicion as well as good history and physical examination skills are necessary to achieve an adequate diagnosis. Multidisciplinary teams form the cornerstone of a patient-tailored approach to its management.