Microvascular Decompression for Hemifacial Spasm: Surgical Technical nuances and results after 300 microvascular decompression surgeries

Authors

Rogelio Revuelta Gutiérrez, Neurosurgery Department, National Institute of Neurology and Neurosurgery, Mexico City, MexicoFollow
Miguel Vega-Arroyo, Neurosurgery Department, Instituto Nacional de Neurología y NeurocirugíaFollow
Olivia L. Vales-Hidalgo, Neuro-Otology Department Instituto Nacional de neurología y NeurocirugíaFollow
Cynthia E. López-Rafael, Neurosurgery Department, Instituto Nacional de Neurología y NeurocirugíaFollow
Jesús Martínez-Manrique, Neurosurgery Department, Instituto Nacional de Neurología y NeurocirugíaFollow
Sergio Moreno Jiménez, The American-British Cowdray Medical Center IAPFollow

Corresponding Author

Dr. Rogelio Revuelta-Gutierrez

Department of Neurosurgery at the National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico. Zip code 14269. Tel: (55) 56-06-38-22. E-mail: rogelio7revuelta@gmail.com

Document Type

Original Research - Functional Surgery

Abstract

Introduction: Hemifacial spasm (HFS) is characterized by the involuntary, paroxysmal, painless, and progressive spasmodic contractions of facial muscles innervated by the ipsilateral seventh cranial nerve. To date, neuroimaging studies (Computed Tomography scan [CT] and Magnetic Resonance Imaging [MRI]) are unable to establish the diagnosis. HFS medical treatment with antiepileptic drugs, and Botulinum toxin application are temporarily effective, however, both have shown side effects and lesser cost-effective results. Currently, surgical Micro Vascular Decompression (MVD) for HFS has the highest curative rates and lower operative morbidity. We analyze the demographics, clinical manifestations, outcomes, and complications that to our knowledge, is the largest Latin-American patient’s series treated for HFS through a keyhole microasterional craniectomy. Objective: The authors report the results of 300 Microvascular Decompression (MVD) for Hemifacial Spasm (HFS) in 265 patients due to nerve attrition by the neurovascular etiology, triggering of ectopic action potentials from the demyelinated facial nerve fibers. Methods: We reviewed and analyzed the clinical data from the medical records of patients treated by MVD for HFS from May 1992 to December 2018. Both preoperative MRI and audiometry studies were assessed in all patients as part of preoperatively evaluation. Patients with secondary causes of HFS such as tumors were excluded. Results: Among them, 168 [63.4%] were women and 97 [36.6%] males. 149 (56.2%) HFS were left-sided and with a better outcome compared to the 116 (43.8%) located on right side (p=0.22). The two main culprit vessels were AICA in 188 (70.9%) followed by PICA in 20 (7.5%). The basilar artery was identified in 14 (5.3%) and SUCA in 13 (4.9%). Conclusions: MVD through a retractorless microasterional approach is a very effective and a safe technique for treating HFS. Failure to HFS improvement after 1-week of MVD warrants immediate reoperation. In addition, MVD is a safe, the most effective technique and the only curative treatment for HFS.

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Recommended Citation

Revuelta Gutiérrez, Rogelio; Vega-Arroyo, Miguel; Vales-Hidalgo, Olivia L.; López-Rafael, Cynthia E.; Martínez-Manrique, Jesús; and Moreno Jiménez, Sergio (2022) "Microvascular Decompression for Hemifacial Spasm: Surgical Technical nuances and results after 300 microvascular decompression surgeries," Archives of Neurosurgery: Vol. 1: Iss. 2, Article 2.
DOI: https://doi.org/10.71119/2992-8478.1010
Available at: https://www.ansjournal.org/home/vol1/iss2/2