Fully Endoscopic Microvascular Decompression for Hemifacial Spasm Using Improved Retrosigmoid Infrafloccular Approach: Clinical Analysis of 81 Cases.

Abstract

Microvascular decompression (MVD) is widely accepted as the preferred treatment for hemifacial spasm (HFS). Endoscopy has been implemented to provide a comprehensive view of neurovascular conflicts and minimize the damage caused by brain retraction while exploring the facial nerve root exit zone of the brain stem. To preliminarily evaluate the surgical safety and efficacy of fully endoscopic MVD for HFS using an improved retrosigmoid infrafloccular approach. The clinical data of 81 patients with HFS who underwent fully endoscopic MVD using an improved endoscopic retrosigmoid infrafloccular approach from June 2019 to December 2020 were retrospectively analyzed. The reliability and advantages of this surgical technique in the treatment of HFS were evaluated according to the intraoperative situation, outcomes of postoperative symptoms, and main complications. During the follow-up period, 77 cases (95.1%) were completely cured, with immediate facial twitch disappearance in 56 cases and a delayed cure in 21 cases; in 4 cases (4.9%), there was no obvious improvement. There were no cases of recurrence. There were 4 cases (4.9%) of transient facial paralysis after MVD, all of which were completely cured in 3 months. Three cases (3.7%) had hearing loss postoperatively, of whom 2 showed good improvement. At the end of the follow-up period, 1 case (1.2%) still had tinnitus. There were no cases of postoperative intracranial hemorrhage, cerebellar swelling, or death. Fully endoscopic MVD using an improved retrosigmoid infrafloccular approach not only has the advantages of panoramic surgical visualization but also takes into account the requirements of minimally invasive surgery.