Endoscopic Microvascular Decompression for Hemifacial Spasm

Maruf Matmusaev; R Senthil Kumar; Yasuhiro Yamada; Tetsuya Nagatani; Tsukasa Kawase; Riki Tanaka; Miyatani Kyosuke; Yoko Kato

doi:10.4103/ajns.AJNS_152_20

Endoscopic Microvascular Decompression for Hemifacial Spasm

Asian J Neurosurg. 2020 Oct 18;15(4):833-838. doi: 10.4103/ajns.AJNS_152_20. eCollection 2020 Oct-Dec.

Authors

Maruf Matmusaev¹, R Senthil Kumar², Yasuhiro Yamada³, Tetsuya Nagatani⁴, Tsukasa Kawase³, Riki Tanaka³, Miyatani Kyosuke³, Yoko Kato³

Affiliations

¹ Republican Specialized Scientific and Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan.
² Department of Neurosurgery, Royal Care Super Speciality Hospital, Coimbatore, Tamil Nadu, India.
³ Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan.
⁴ Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.

Abstract

Introduction and objective: Hemifacial spasm (HFS) is a condition, characterized by painless, involuntary unilateral tonic or clonic contractions of the facial muscles innervated by the ipsilateral facial nerve. HFS starts with contractions in the orbicularis oculi muscle with subsequent eyelid closure and/or eyebrow elevation, but may spread to involve muscles of the frontalis, platysma, and orbicularis oris muscles. Microvascular decompression (MVD) is reliable and accepted surgical treatment for HFS. MVD is the standard surgical technique now for HFS treatment with long-term success rates.

Materials and methods: We performed fully endoscopic MVD technique for 1 patient with HFS (a 83-year-old female) at our institution. HFS was diagnosed based on the clinical history and presentation, a neurologic examination, and additional imaging findings. Respectively, the durations of HFS were 3 years, respectively. The patient had been previously treated with repeated botulinum toxin injections. Preoperative evaluation was done with magnetic resonance imaging; three-dimensional computed tomography fusion images examinations had identified the anterior inferior cerebellar artery (AICA) as the offending vessel in this patient.

Results: The patient with HFS was treated by fully endoscopic MVD technique. The AICA, which had been identified as the offending vessel by preoperative magnetic resonance imaging, was successfully decompressed. No surgery-related complications occurred and had excellent outcomes with the complete resolution of HFS immediately after the operation.

Conclusions: Endoscopic surgery can provide a more panoramic surgical view than conventional microscopic surgery. Fully endoscopic MVD is both safe and effective in the treatment of HFS. This method minimizes the risks of brain retraction and extensive dissection often required for microscopic exposure. Endoscopic MVD is safe and has advantage over microscope in terms of visualization of structure, identification of neurovascular conflict, but it has a learning curve and technically challenging.

Keywords: Endoscope; facial nerve root exit zone; hemifacial spasm; microvascular decompression.

Publication types

Review