Microvascular decompression for hemifacial spasm involving the vertebral artery

Jing Wang,Yulong Chong,Lianshu Ding,Weibang Liang,Chengrong Jiang,Yuxiang Dai

doi:10.1007/s00701-021-05076-8

Jing Wang, Yulong Chong + Show 4 more

Open Access

https://doi.org/10.1007/s00701-021-05076-8

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Abstract

ObjectiveMicrovascular decompression (MVD) has become an accepted treatment modality for the vertebral artery (VA)–involved hemifacial spasm (HFS). The aim of this retrospective study was to evaluate clinical and surgical outcomes of HFS patients undergoing MVD and surgical and cranial nerve complications and investigate reasonable transposition procedures for two different anatomic variations of VA.MethodsBetween January and December 2018, 109 patients underwent first MVD for HFS involving VA at Nanjing Drum Tower Hospital. Based on whether the VA could be moved ventrally at the lower cranial nerves (LCNs) level, patients were assigned to Group A (movable VA, n = 72) or B (unmovable VA, n = 37), and clinical and surgical outcomes and complications on the day of post-surgery and during follow-up were assessed. All patients were followed up ranging from 17 to 24 months with a mean follow-up period of 21 months.ResultsAfter a mean follow-up of 21 months, the total cure rate significantly decreased in all patients compared to that achieved on the day of surgery, and Group A patients exhibited a higher cure rate versus Group B (93.1% vs. 75.7%, P = 0.015). Group B patients with unmovable VA revealed both higher incidence of surgical complications (45.9% vs. 15.3%, P = 0.001) and frequency of bilateral VA compression (27% vs. 8.3%, P = 0.009) versus Group A. No significant difference was observed in long-term cranial nerve complications.ConclusionsVA-involved HFS can benefit from MVD strategies after preoperative assessment of VA compression. HFS patients with movable VA may receive better long-term efficacy and fewer complications. A Teflon bridge wedged between the distal VA and medulla gives rise to adequate space for decompression surgery.

Highlights

Hemifacial spasm (HFS) is a rare neurovascular movement disorder characterized by unilateral, irregular, and paroxysmal facial muscle contractions [3, 10, 16]
We retrospectively reviewed clinical data from 112 patients with vertebral artery (VA)-involved HFS and assessed the relationship between compression pattern and anatomic variations
Patients were assigned to Group A, whose axial T2-weighted Magnetic resonance imaging (MRI) demonstrated adequate space between the VA and petrosal bone at lower cranial nerves (LCNs) level; otherwise, patients were assigned to Group B

Summary

Introduction

Hemifacial spasm (HFS) is a rare neurovascular movement disorder characterized by unilateral, irregular, and paroxysmal facial muscle contractions [3, 10, 16]. The most common cause is the vascular compression of the facial nerve at its root exit zone (REZ) in the brainstem. When vertebral artery (VA) compression occurs and directly results in HFS, adequate mobilization of VA is a determinant for successful treatment and persistent efficacy of procedures [8]. Through shifting the VA in the ventral direction by inserting the Teflon pieces into the space between the VA and brainstem at more points, we found it was relatively useful and simple to operate. There is not enough space for partial VA-involved HFS to move the VA ventrally. We retrospectively reviewed clinical data from 112 patients with VA-involved HFS and assessed the relationship between compression pattern and anatomic variations

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