Abstract
Objective: Microvascular decompression (MVD) surgery has been accepted as a minimally invasive surgical modality for the treatment of hemifacial spasm (HFS). However, the size of the bone window does not match the concept of minimally invasive. This study is aimed at evaluating the efficacy and safety of <2 cm micro-keyhole MVD.Methods: A total of 148 patients with HFS diagnosed in the First Affiliated Hospital of Chongqing Medical University from January 1, 2019, to July 1, 2020, who underwent MVD in the neurosurgery department of the hospital were collected. Surgery was performed by a retrosigmoid keyhole approach with the bone hole diameter <2 cm, which was named micro-keyhole MVD. The efficacy and safety of the micro-keyhole MVD were evaluated by statistical analysis of the efficacy of the micro-keyhole MVD and the incidence of postoperative complications.Results: The effect of micro-keyhole MVD was satisfying (cure or partial remission) in 97.2% (n = 144). The failure and recurrence rates were 2.7% (n = 4) and 0.6% (n = 1), respectively. Among them, immediate facial palsy, delayed facial palsy, hearing loss, and cerebrospinal fluid (CSF) leakage were found in 0.6% (n = 1), 8.1% (n = 12), 4.7% (n = 7), and 1.3% (n = 2). Only one patient developed cerebellar infarction, which was complicated by “moyamoya disease.” The micro-keyhole MVD in the treatment of HFS can achieve a high remission rate and reduce the incidence of surgical complications.Conclusion: Micro-keyhole MVD is a safe and effective minimally invasive treatment for HFS. This technique does not increase the incidence of cranial nerve injury. Meanwhile, it reduces the incidence of CSF leakage and hearing loss (HL).
Highlights
For primary hemifacial spasm (HFS), the most commonly proposed etiology is neurovascular compression (NVC) at the root exit zone (REZ) of the facial nerve [1]
We retrospectively reviewed the medical records of 148 patients who underwent micro-keyhole microvascular decompression (MVD) via a retrosigmoid keyhole approach between January 2019 and July 2020
All other results were assigned a grade of “failure.” All grades were assessed within 24 h after micro-keyhole MVD
Summary
For primary hemifacial spasm (HFS), the most commonly proposed etiology is neurovascular compression (NVC) at the root exit zone (REZ) of the facial nerve [1]. Proposed in 1962 and described detailedly in 1999 [7], MVD had gradually become a wild-accepted treatment for HFS. In the first 10 years of the 20th century, with the advancement of technology, the size of the bone window gradually decreased to 3 cm [8]. In the past 10 years, due to the development of endoscopic technology, the bone window of MVD was more minimally invasive, and the diameter has reduced to
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