Microvascular Decompression Of Facial Nerve Research Articles

Retrospective study of the combined application of the blink reflex and lateral spread reflex in microvascular decompression of facial nerve surgery.

The blink reflex (BR) can be used as a routine monitoring method during facial nerve microvascular decompression. This study aimed to investigate whether the use of the BR in hemifacial spasm (HFS) surgery is comparable to that of the lateral spread reflex (LSR), and to explore its significance for guiding intraoperative neurophysiological monitoring (IONM). Patients undergoing facial nerve microvascular decompression from 2016 to 2018 were included in the study. According to the results of IONM, the intraoperative monitoring items of the BR and two conventional facial nerve microvascular decompression procedures, namely the marginal mandibular branch LSR (MAR-LSR) and zygomatic branch LSR (ZYG-LSR), were compared. We mainly compared whether there were differences in the occurrence rate, disappearance rate, waveform, occurrence current, and prognosis of the three monitoring methods. The occurrence rate of the BR was lower than that of the MAR-LSR and ZYG-LSR, as well as the three combined detection groups. The disappearance rate of the BR was not different to that of the MAR-LSR, but higher than that of the ZYG-LSR group. In addition, the waveform of the BR showed differences from that of the MAR-LSR and ZYG-LSR. The incidence of postoperative residual symptoms in patients with any kind of reflex on the first day after surgery and the day of discharge was significantly higher than that of patients in which all three reflexes disappeared. Combined BR and LSR monitoring can reduce the occurrence of postoperative residual symptoms. We suggest that by increasing the use of BR examination during surgery, the integrity of the trigeminal nerve can be protected.

Microvascular decompression for hemifacial spasm: a review of twenty-one operated cases

BackgroundMicrovascular decompression of facial nerve provides definitive and long-term cure for hemifacial spasm. We review our experience of treating hemifacial spasm by microvascular decompression.ObjectivesTo evaluate the results of microvascular decompression of facial nerve for hemifacial spasm and to discuss the critical steps during surgery necessary to achieve a good result.Patients and methodsTwenty-one cases of hemifacial spasm operated by the author were analysed. All the patients underwent microvascular decompression of the facial nerve by the retromastoid approach. Preoperative and postoperative videos of the patients were made with their consent. Patient outcome and complications were analysed.ResultsTwenty patients had complete resolution of the spasm after surgery. The second operated patient had facial palsy with hearing loss in the immediate postoperative period and recurrence of the spasm after 6 months of surgery. Postoperative mild transient facial weakness in one patient, mild sensory-neural hearing loss in two, delayed facial palsy which resolved completely in two patients, transient facial twitching which responded to carbamazepine in one and paradoxical CSF rhinorrhea treated successfully by lumbar drainage in one patient were the complications noted.ConclusionHemifacial spasm is best treated by surgery, and our results compare favourably with those in the existing literature. Sensorineural hearing loss and facial nerve palsy are the main complications to be expected during the learning curve.

Microstructure and Reasonable Management of the Arachnoid Associated with the Infrafloccular Approach for Microvascular Decompression of the Facial Nerve.

To understand the arachnoid microstructure during infrafloccular approach for facial nerve microvascular decompression (MVD). This study recruited 55 patients with hemifacial spasm who underwent MVD. Retrospective analyses of the MVD surgical videos were performed to reveal the arachnoid microstructure during the procedures. Cadaveric head specimens (n=8, on 16 sides) were dissected for observation of the microstructure of the arachnoid in the cerebellopontine angle. The arachnoid membrane surrounding the facio-cochleovestibular and lower cranial nerves forms two arachnoid sheaths. Both arachnoid sheaths contain two parts: the outer membranous and inner trabecular part. The membranous part is an intact and translucent membrane that wraps around nerves. The inner trabecular part is located beneath the membranous part and forms a trabecular network that connects the membranous arachnoid, nerves, and blood vessels to form a physical structure. The arachnoid connects the facio-cochleovestibular and lower cranial nerves, blood vessels, and cerebellum as a complex physical entity. Therefore, during MVD surgery, sharply dissecting the arachnoid before retracting the flocculus and relocating the offending vessels helps reduce nerve injury.

Effect of partial neuromuscular blockade on efficacy and safety of nerve monitoring during microvascular decompression of facial nerve

Objective To evaluate the effect of partial neuromuscular blockade (NMB) on the efficacy and safety of nerve monitoring during microvascular decompression (MVD) of facial nerve. Methods Seventy American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 39-78 yr, weighing 44-84 kg, scheduled for elective MVD, were divided into 2 groups (n=35 each) using a random number table method: control group and partial NMB group.Anesthesia was induced by intravenous injection of 3-fold ED95 cisatracurium.In control group, muscle relaxants were not used after intubation.In partial NMB group, cisatracurium was continuously infused intravenously to maintain partial NMB, and the T1/Tc ratio was maintained at 20%-40%.Intraoperative neuroelectrophysiological monitoring was performed using lateral spread response (LSR). The success rates of LSR monitoring, occurrence of body movement, requirement for anesthetics and cardiovascular agents were recorded during operation, and the patients were followed up on day 7 after surgery, and the therapeutic efficacy and occurrence of neurological complications were recorded. Results Compared with control group, the incidence of intraoperative body movement was significantly decreased, the intraoperative consumption of propofol and remifentanil was decreased, and the intraoperative requirement for vasopressors was decreased in partial NMB group (P 0.05). Conclusion Partial NMB (T1/Tc=20%-40%) can be effectively used for MVD monitored by LSR, decrease the occurrence of the body movement, and raise the perioperative safety in patients. Key words: Muscle relaxation; Facial nerve; Microvascular decompression surgery; Monitoring, intraoperative

Clinical application of endoscope combined with microscope for the microvascular decompression in hemifacial spasm

Objective: To evaluate the effectiveness and safety of the endoscope combined with microscope for the microvascular decompression in hemifacial spasm. Methods: A total of 26 patients underwent endoscope combined with microscopic facial nerve microvascular decompression through retrolabyrinthine approach from January 2013 to December 2016 were retrospectively reviewed in Ear Institute, Shanghai Jiaotong University School of Medicine. Among them, 9 were male and 17 were female, with a mean age of (51.9±11.4) years;15 cases of left side and 11 of right side patients were followed up for 1-3 years. The pre-and post-operative Cohen Classification was used for hemifacial spasm, House-Brackmann Grade for facial nerve function, hearing level and complication rates were reviewed. SPSS 19.0 software was used to analyze the data. Results: All 26 patients were operated successfully. No recurrence was seen during 1-3 year follow-up. Post-operative Cohen Grade were as follows: 25 cases with Cohen Grade I and 1 case with Cohen Grade II. The difference in Cohen grade between pre-and post-operative was statistically significant (Z=-4.87, P<0.01). Post-operative facial nerve function was satisfactory in all patients (House-Brackmann Grade I-II in all patients). No hearing loss was observed. No facial paralysis and other lower cranial nerve dysfunction were observed. No postoperative complications such as cerebrospinal fluid leakage occurred. Conclusions: Using an angled endoscope combined with microscope in microvascular decompression in hemifacial spasmis is safe and effective.

Microvascular Decompression of Facial Nerve and Pexy of the Left Vertebral Artery for Left Hemifacial Spasm: 3-Dimensional Operative Video.

A 73-yr-old man presented with intractable left hemifacial spasm of 4 yr duration. Brain magnetic resonance imaging showed significant compression of left facial nerve by the left vertebral artery (VA) and anterior inferior cerebellar artery (AICA).The patient underwent a left retrosigmoid craniotomy and a microvascular decompression of the cranial nerve (CN) VII. Intraoperatively, we found that the distal AICA had a protracted subarcuate extradural course.1 This was relieved by intra/extradural dissection. The left VA and the AICA loop were compressing the root exit zone of CN VII. The VA was mobilized, and pexy into the petrosal dura was done with 8-0 nylon sutures (Ethilon Nylon Suture, Ethicon Inc, a subsidiary of Johnson & Johnson, Somerville, New Jersey). Once this was done, the lateral spread disappeared.2 The AICA loop was decompressed with 2 pieces of Teflon felt (Bard PTFE felt, Bard peripheral Vascular Inc, a subsidiary of CR Bard Inc, Temp, Arizona). After this, wave V of the brainstem auditory evoked potential (BAEP) disappeared completely, with no recovery despite the application of the nicardipine on the internal auditory artery (IAA). The IAA appeared to be stretched by the microvascular decompression. Arachnoidal dissection was done to release the CN VIII and an additional felt piece was placed to elevate the AICA loop; the BAEP recovered completely. The patient had a complete disappearance of the hemifacial spasm postoperatively, and hearing was unchanged.This 3-D video shows the technical nuances of performing a vertebropexy, release of the AICA from its extradural subarcuate course, and the surgical maneuvers in the event of an unexpected change in neuromonitoring response. The suture technique of vertebropexy is preferred to a loop technique, to avoid kinking of the VA.3Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience

IntroductionThe use of surgical decompression of facial hemispasm due to the loop in the internal auditory canal is not always accepted due to the risk related to the surgical procedure. Currently a new surgical technique allows surgeons to work in safer conditions. ObjectiveTo report the results with endoscope-assisted retrosigmoid approach for facial nerve microvascular decompression in hemifacial spasm due to neurovascular conflict. The surgical technique is described. MethodsWe carried out a prospective study in a tertiary referral center observing 12 (5 male, 7 female) patients, mean age 57.5 years (range 49–71) affected by hemifacial spasm, that underwent to an endoscope assisted retrosigmoid approach for microvascular decompression. We evaluated intra-operative findings, postoperative HFS resolution and complication rates. ResultsHemifacial spasm resolution was noticed in 9/12 (75%) cases within 24h after surgery and in 12/12 (100%) subjects within 45 days. A significant (p<0.001) correlation between preoperative historical duration of hemifacial spasm and postoperative recovery timing was recorded. Only 1 patient had a complication (meningitis), which resolved after intravenous antibiotics with no sequelae. No cases of cerebrospinal fluid leak, facial palsy or hearing impairment were recorded. Hemifacial spasm recurrence was noticed in the only subject where the neurovascular conflict was due to a vein within the internal auditory canal. ConclusionsThe endoscope assisted retrosigmoid approach technique offers an optimal visualization of the neurovascular conflict thorough a minimally invasive approach, thus allowing an accurate decompression of the facial nerve with low complication rates. Due to the less invasive nature, the procedure should be considered in functional surgery of the cerebellar pontine angle as hemifacial spasm treatment, specially when the procedure is performed by an otolaryngologist.

Clinical observation of laryngeal mask airway I-gel in patients undergoing microvascular decompression of facial nerve

Objective To assess the efficacy of laryngeal mask airway I-gel(LMA I-gel) in patients undergoing microvascular decompression of facial nerve. Methods Ninety ASA patients withⅠ or Ⅱ of both sexes, aged 20-55 y, body mass index of 18-25 kg/m2, of Mallampati Ⅰ-Ⅲ, undergoing microvascular decompression of facial nerve, were completely randomly divided into 3 groups(n=30): I-gel group (group I), Supreme group (group S), endotracheal intubation group(group Q). The time spent for intubation and success rate of intubation for the first time were recorded in the three groups, Oropharyngeal leak pressure and fiberoptic laryngoscopy scores were observed in lateral position in group I and group S. Vital signs were monitered after entering the operating room(T0), before intubation(T1), intubation(T2), before extubation(T3) extubation immediately(T4). The extubation time of laryngeal mask and tracheal catheter and consciousness recovery time were observed. The postoperative cough, sore throat, nausea, vomiting and other adverse reactions were recorded too. Results Regarding the time spent for intubation, group I and group S was shorter than group Q[(12±3), (16±4) s vs (30±6) s](P 0.05). Oropharyngeal leak pressure in lateral position was more higher in group I than in group S[(28±3) cmH2O(1 cmH2O=0.098 kPa) vs (24±4) cmH2O](P 0.05). Conclusions Laryngeal mask I-gel, laryngeal mask supreme and tracheal can be used effectively for microvascular decompression of facial nerve, but laryngeal mask I-gel can provide adequate ventilation during operation with less complications, more easy insertion and more stable hemodynamics. Key words: Laryngeal mask; Microvascular decompression of facial nerve; Airway management

Effects of botulinum toxin on electrophysiological monitoring the lateral spread response in the facial nerve microvascular decompression surgery

Objective To investigate the effects of facial injecting botulinum toxin on electrophysiological monitoring indicator lateral spread response (LSR) in patients with hemifacial spasm in microvascular decompression surgery. Methods Ninety patients with facial spasm underwent microvascular decompression surgery in Guangdong No 2 Provincial People's Hospital from July 2013 to December 2014 were enrolled retrospectively. They were divided into either a botulinum toxin group (n=18) or a non-botulinum toxin group (n=72) according to whether they injected botulinum toxin or not. The effect of botulinum toxin on the changes of intraoperative LSR and the role of LSR changes in prognostic evaluation were observed. Results The mean LSR latency of the zygomatic branch in the botulinum toxin group was 11.4±2.1 ms, and in the non-botulinum toxin group was 9.3±1.4 ms. There was significant difference (P 0.05). The LSR amplitude of the zygomatic branch in botulinum toxin group was 116.1±61.1 μV, and in mandibular branch was 116.1±54.5 μV; the zygomatic branch was 125.9±52.1 μV, and the mandibular branch was 125.9±52.1 μV in the non-botulinum toxin group. There was no significant difference between the 2 groups. After implantation of shims, the LSR disappear rates of zygomatic branchs, and mandibular branch were 16/18and 17/18 respectively in the botulinum toxin group; the zygomatic branch disappear rate in the non-botulinum toxin group was 90% (65/72) and that in the mandibular branch was 96% (69/72). There was no significant difference between the 2 groups (P>0.05). The sensitivity of the disappearance of zygomatic branch LSR for prognostic judgment in the botulinum toxin group was 94% (15/16), and in the non-botulinum toxin group was 98% (64/65). There was significant difference (P<0.05). The mandibular branch LSR, and the sensitivities of both zygomatic branch and mandibular branch disappeared simultaneously for prognostic judgment in the botulinum toxin group were 94% (16/17) and 94% (15/16) respectively; and in the non-botulinum toxin group were 92% (64/69) and 96% (59/61) respectively. There was no significant difference between the 2 groups. Conclusions Botulinum toxin has influence on intraoperative LSR. It is expressed as the prolonged LSR latency of zygomatic branch. The way of monitoring with mandibular branch or in combination with zygomatic branch LSR may be better than simply monitoring zygomatic branch LSR. Key words: Microvascular decompression surgery; Nervous system physiological processes; Hemifacial spasm; Botulinum toxins; Lateral spread response

Neuralgies of the lower cranial nerves: Microsurgical posterior fossa exploration

Neuralgias of the lower cranial nerves are trigeminal neuralgia (TN), glossopharingeal neuralgia (GphN), and geniculate neuralgia (GN). Microsurgical posterior fossa exploration with its variations microvascular decompression (MVD), partial sensory rhisotomy (PSR), and total sensory rhisotomy (TSR) is one of the most efficient ways of treating these neuralgias. It was performed 130 operations in 125 patients with TN, 3 in GphN patients, 1 in GN patient, 1 in GN/TN patients, 1 in GphN/GN patient, and 2 in GN/hemifacial spasm patients. Of total of 125 patients with TN, MVD was performed in 63, PSR in 18, and MVD+PSR in 44 cases. In 5 patients with recidivate TN PSR was performed. Of total 3 patients with GphN MVD was performed in 2 cases, and extirpation of a small meningeoma in 1 case (it was not seen on CT). In the patients with GN TSR of intermediate nerve was performed, in GN/TN patients TSR of intermediate nerve and PSR of trigeminal nerve was performed, in the GN/GphN patients MVD of glossopharingeal and TSR of intermediate nerve were performed, and in the GN/hemifacial spasm patients TSR of intermediate and MVD of facial nerve were performed. The results of TN patients are: excellent in 82.4%, good in 12%, and poor in 5.6% of patients. There is no difference in complete pain relief, rate of recurrence, and complications between MVD, MVD+PSR and PSR operative groups (p0.05). Among patients with other neuralgias the following results are noted: excellent in 4, good in 3, and poor in 1 patient. Microsurgical posterior fossa exploration is the method of choice in the treatment of the neuralgias of the lower cranial nerves.