Bao-Hui Feng1, Xue-Sheng Zheng1, Xu-Hui Wang1, Ting-Ting Ying1, Min Yang1, Yin-Da Tang1, Shi-Ting Li2. 1. Department of Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, 200092, China. 2. Department of Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, 200092, China. xinhuaneuro@163.com.
Abstract
BACKGROUND: In hemifacial spasm, it is extremely rare to find a vessel passing through the facial nerve. In this study, we present our experience of the surgical treatment of four such patients. METHODS: From January 2010 to Match 2015, we treated 2,576 hemifacial spasm patients with microvascular decompression in our department. Of these, four had an intraneural vessel. Intraoperative findings and treatment were recorded, and postoperative outcomes were analyzed. RESULTS: In three patients, the intraneural vessel was the anterior inferior cerebellar artery, which we wrapped with small pieces of wet gelatin and Teflon sponge. A small vein found in the fourth patient was treated with facial nerve combing. Complete decompression was achieved and abnormal muscle response disappeared. Three patients got an excellent result and one patient got a good result. One patient had postoperative facial paralysis, which improved over 10 months of follow-up. CONCLUSION: If an artery passes through the facial nerve, it can be decompressed by wrapping the vessel with wet gelatin and Teflon sponge. If a vein passes through the facial nerve, combing can be used. Intraoperative abnormal muscle response monitoring is very helpful in achieving complete decompression.
BACKGROUND: In hemifacial spasm, it is extremely rare to find a vessel passing through the facial nerve. In this study, we present our experience of the surgical treatment of four such patients. METHODS: From January 2010 to Match 2015, we treated 2,576 hemifacial spasmpatients with microvascular decompression in our department. Of these, four had an intraneural vessel. Intraoperative findings and treatment were recorded, and postoperative outcomes were analyzed. RESULTS: In three patients, the intraneural vessel was the anterior inferior cerebellar artery, which we wrapped with small pieces of wet gelatin and Teflon sponge. A small vein found in the fourth patient was treated with facial nerve combing. Complete decompression was achieved and abnormal muscle response disappeared. Three patients got an excellent result and one patient got a good result. One patient had postoperative facial paralysis, which improved over 10 months of follow-up. CONCLUSION: If an artery passes through the facial nerve, it can be decompressed by wrapping the vessel with wet gelatin and Teflon sponge. If a vein passes through the facial nerve, combing can be used. Intraoperative abnormal muscle response monitoring is very helpful in achieving complete decompression.
Authors: Giampietro Ricci; Arianna Di Stadio; Luca D'Ascanio; Ruggero La Penna; Franco Trabalzini; Antonio Della Volpe; Jacques Magnan Journal: Braz J Otorhinolaryngol Date: 2018-05-09