Skip to main content
SpringerLink
Log in

Fully endoscopic microvascular decompression of the hemifacial spasm: our experience

  • Technical Note - Neurosurgical technique evaluation
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Purpose

Microvascular decompression (MVD) surgery has been accepted as a potentially curative method for hemifacial spasm (HFS). The primary cause of failure of MVD is incomplete decompression of the offending vessel due to inadequate visualization. This study is aimed at evaluating the benefit of endoscopic visualization and the value of fully endoscopic MVD.

Methods

From March 2016 to March 2018, 45 HFS patients underwent fully endoscopic MVD in our department. From opening the dura to preparing to close, the assistant held the endoscope and the surgeon operated. Abnormal muscle response (AMR) and brainstem auditory evoked potentials (BAEP) were monitored. For every patient, the offending vessel was transposed or interposed and achieved complete decompression. AMR was used to evaluate the adequacy of decompression at the end of the surgery. The intra-operative findings and postoperative outcomes and complications were analyzed.

Results

Immediately after surgeries, 39 patients (86.7%) achieved excellent result; 2 cases (4.4%) had good result. So the postoperative effective rate was 91.1% (41/45). During 12–36 month follow-up, the outcomes were excellent in 42 cases (93.3%) and good in 2 cases (4.4%), and the effective rate reached to 97.8% (44/45). No recurrence was noted. The postoperative complications were found in 2 patients (4.4%). One patient (2.2%) showed delayed facial palsy on the tenth day but was fully recovered 1 month later. Intracranial infection was noticed in 1 patient (2.2%) and was cured by using intravenous antibiotics for 2 weeks. There was no hearing impairment, hoarseness, or other complications.

Conclusions

Fully endoscopic MVD is both safe and effective in the treatment of HFS. Electrophysiological monitoring is helpful to gain a good result and reduce hearing impairment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Badr-El-Dine M, El-Garem HF, Talaat AM, Magnan J (2002) Endoscopically assisted minimally invasive microvascular decompression of hemifacial spasm. Otol Neurotol 23:122–128

    Article  CAS  Google Scholar 

  2. Barker FG, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD (1995) Microvascular decompression for hemifacial spasm. J Neurosurg 82(2):201–210

    Article  Google Scholar 

  3. Bigder MG, Kaufmann AM (2016) Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations. J Neurosurg 124(1):90–95

    Article  Google Scholar 

  4. Campos-Benitez M, Kaufmann AM (2008) Neurovascular compression findings in hemifacial spasm. J Neurosurg 109(3):416–420

    Article  Google Scholar 

  5. Cheng WY, Chao SC, Shen CC (2008) Endoscopic microvascular decompression of the hemifacial spasm. Surg Neurol Suppl 1(S1):40–46

    Article  Google Scholar 

  6. Eby JB, Cha ST, Shahinian HK (2001) Fully endoscopic vascular decompression of the facial nerve for hemifacial spasm. Skull Base 11(3):189–197

    Article  CAS  Google Scholar 

  7. El Damaty A, Rosenstengel C, Matthes M, Baldauf J, Dziemba O, Hosemann W, Schroeder HWS (2017) A new score to predict the risk of hearing impairment after microvascular decompression for hemifacial spasm. Neurosurgery 81(5):834–843

    PubMed  Google Scholar 

  8. El Refaee E, Langner S, Marx S, Rosenstengel C, Baldauf J, Schroeder HWS (2019) Endoscope-assisted microvascular decompression for the management of hemifacial spasm caused by vertebrobasilar dolichoectasia. World Neurosurg 121:e566–e575

    Article  Google Scholar 

  9. El Refaee E, Marx S, Rosenstengel C, Baldauf J, Schroeder HWS (2020) Arachnoid bands and venous compression as rare causes of hemifacial spasm: analysis of etiology in 353 patients. Acta Neurochir 162(1):211–219

    Article  Google Scholar 

  10. Feng BH, Zheng XS, Wang XH, Ying TT, Yang M, Tang YD, Li ST (2015) Management of vessels passing through the facial nerve in the treatment of hemifacial spasm. Acta Neurochir 157(11):1935–1940

    Article  Google Scholar 

  11. Flanders TM, Blue R, Roberts S, McShane BJ, Wilent B, Tambi V, Petrov D, Lee JYK (2018) Fully endoscopic microvascular decompression for hemifacial spasm. J Neurosurg 131(3):813–819

    Article  Google Scholar 

  12. Halpern CH, Lang SS, Lee JY (2013) Fully endoscopic microvascular decompression: our early experience. Minim Invasive Surg 2013:739432

    PubMed  PubMed Central  Google Scholar 

  13. Iijima K, Tajika Y, Tanaka Y, Yorifuji H, Yoshimoto Y (2018) Microanatomy around the facial nerve pathway for microvascular decompression surgery investigated with correlative light microscopy and block-face imaging. World Neurosurg 118:e526–e533

    Article  Google Scholar 

  14. Jannetta PJ, Abbasy M, Maroon JC, Ramos FM, Albin MS (1977) Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg 47:321–328

    Article  CAS  Google Scholar 

  15. Lee S, Park SK, Lee JA, Joo BE, Park K (2019) Missed culprits in failed microvascular decompression surgery for hemifacial spasm and clinical outcomes of redo surgery. World Neurosurg 129:e627–e633

    Article  Google Scholar 

  16. Lu AY, Yeung JT, Gerrard JL, Michaelides EM, Sekula RF Jr, Bulsara KR (2014) Hemifacial spasm and neurovascular compression. Sci World J 2014:349319

    Google Scholar 

  17. Magnan J (2018) Endoscope-assisted decompression of facial nerve for treatment of hemifacial spasm. Neurochirurgie 64(2):144–152

    Article  CAS  Google Scholar 

  18. Magnan J, Chays A, Lepetre C, Pencroffi E, Locatelli P (1994) Surgical perspectives of endoscopy of the cerebellopontine angle. Am J Otol 15:366–370

    CAS  PubMed  Google Scholar 

  19. Mercier P, Bernard F (2018) Surgical anatomy for hemifacial spasm. Neurochirurgie 64(2):124–132

    Article  CAS  Google Scholar 

  20. Mercier P, Sindou M (2018) The conflicting vessels in hemifacial spasm: literature review and anatomical-surgical implications. Neurochirurgie 64(2):94–100

    Article  CAS  Google Scholar 

  21. O’Donoghue GM, O’Flynn P (1993) Endoscopic anatomy of the cerebellopontine angle. Am J Otol 14:122–125

    Article  Google Scholar 

  22. Rak R, Sekhar LN, Stimac D, Hechl P (2004) Endoscope-assisted microsurgery for microvascular compression syndromes. Neurosurgery 54:876–881

    Article  Google Scholar 

  23. Raslan AM, DeJesus R, Berk C, Zacest A, Anderson JC, Burchiel KJ (2009) Sensitivity of high-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled-gradient recalled imaging in the prediction of neurovascular compression in patients with hemifacial spasm. J Neurosurg 111(4):733–736

    Article  Google Scholar 

  24. Ricci G, Di Stadio A, D’Ascanio L, La Penna R, Trabalzini F, Della Volpe A, Magnan J (2019) Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience. Braz J Otorhinolaryngol 85(4):465–472

    Article  Google Scholar 

  25. Sang SC, Jong HC, Jae YC, Jin WC, Young GP (2001) Microvascular decompression for hemifacial spasm: a long-term follow-up of 1169 consecutive cases. Stereotact Funct Neurosurg 77(1–4):190–193

    Google Scholar 

  26. Sharma R, Garg K, Agarwal S, Agarwal D, Chandra PS, Kale SS, Sharma BS, Mahapatra AK (2017) Microvascular decompression for hemifacial spasm: a systematic review of vascular pathology, long term treatment efficacy and safety. Neurol India 65(3):493–505

    Article  Google Scholar 

  27. Sindou M, Mercier P (2018) Microvascular decompression for hemifacial spasm: outcome on spasm and complications. A review. Neurochirurgie 64(2):106–116

    Article  CAS  Google Scholar 

  28. Sindou MP, Polo G, Fischer C, Vial C (2006) Neurovascular conflict and hemifacial spasm. Suppl Clin Neurophysiol 58:274–281

    Article  CAS  Google Scholar 

  29. Sun H, Li ST, Zhong J, Zhang WC, Hua XM, Wan L, Zheng XS (2014) The strategy of microvascular decompression for hemifacial spasm: how to decide the endpoint of an MVD surgery. Acta Neurochir 156(6):1155–1159

    Article  Google Scholar 

  30. Wu Y, Davidson AL, Pan T, Jankovic J (2010) Asian over-representation among patients with hemifacial spasm compared to patients with cranial-cervical dystonia. J Neurol Sci 298(1–2):61–63

    Article  Google Scholar 

  31. Ying TT, Li ST, Zhong J, Li XY, Wang XH, Zhu J (2011) The value of abnormal muscle response monitoring during microvascular decompression surgery for hemifacial spasm. Int J Surg 9:347–351

    Article  Google Scholar 

  32. Zhao H, Zhu J, Zhang X, Tang YD, Zhou P, Wang XH, Li S (2018) Involved small arteries in patients who underwent microvascular decompression for hemifacial spasm. World Neurosurg 118:e646–e650

    Article  Google Scholar 

  33. Zheng X, Feng B, Hong W, Zhang W, Yang M, Tang Y, Zhong J, Hua X, Li S (2012) Management of intraneural vessels during microvascular decompression surgery for trigeminal neuralgia. World Neurosurg 77:771–774

    Article  Google Scholar 

  34. Zhi M, Lu XJ, Wang Q, Li B (2017) Application of neuroendoscopy in the surgical treatment of complicated hemifacial spasm. Neurosciences (Riyadh) 22(1):25–30

    Article  Google Scholar 

  35. Zhong J, Li ST, Zhu J, Guan HX (2011) Is entire nerve root decompression necessary for hemifacial spasm? Int J Surg 9(3):254–257

    Article  Google Scholar 

  36. Zhu J, Li ST, Zhong J, Guan HX, Ying TT, Yang M, Yang X, Zhou Q, Jiao W (2012) Role of arterioles in management of microvascular decompression in patients with hemifacial spasm. J Clin Neurosci 19(3):375–379

    Article  Google Scholar 

Download references

Funding

Shanghai Jiaotong University provided financial support in the form of Medical and Engineering Cross Foundation (Grant No. YG2016QN68).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, the Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, 200092, China

    Bao-Hui Feng, Wen-Xiang Zhong, Shi-Ting Li & Xu-Hui Wang

  2. Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Chongming Branch, Shanghai, 202150, China

    Xu-Hui Wang

Authors
  1. Bao-Hui Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wen-Xiang Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shi-Ting Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xu-Hui Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xu-Hui Wang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics committee of Xinhua Hospital, Shanghai Jiaotong University School of Medicine.

Informed consent

Informed consent was obtained from all individual participants included in the study.

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Neurosurgical technique evaluation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feng, BH., Zhong, WX., Li, ST. et al. Fully endoscopic microvascular decompression of the hemifacial spasm: our experience. Acta Neurochir 162, 1081–1087 (2020). https://doi.org/10.1007/s00701-020-04245-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-020-04245-5

Keywords

Search

Navigation