Endoscopic Skull Base Surgery
Clinical efficacy of endoscopic microvascular decompression for hemifacial spasm via retrosigmoid infrafloccular approach
Ma Xiangyu, Guo Xing, Zhang Chao, Li Yuexuan, Xu Shujun, Ni Shilei, Li Xin′gang, Li Weiguo
Published 2022-01-28
Cite as Chin J Neurosurg, 2022, 38(1): 29-33. DOI: 10.3760/cma.j.cn112050-20210603-00270
Abstract
ObjectiveTo preliminarily investigate the surgical effect of endoscopic microvascular decompression for hemifacial spasm via retrosigmoid infrafloccular approach.
MethodsA retrospective analysis was conducted on the clinical data of 97 patients with hemifacial spasm admitted to the Department of Neurosurgery, Qilu Hospital of Shandong University from June 2019 to March 2021. Ninety-seven patients underwent preoperative imaging examinations to clarify the relationship between the offending blood vessel and the facial nerve root exit zone (REZ). Neuroendoscopy was used to perform microvascular decompression via the infrafloccular approach. During the operation, the arachnoid membrane on the dorsal side of the cranial nerve was fully dissected under neurophysiological monitoring, so as to expose the REZ of facial nerve, clarify the offending blood vessels, and place the Teflon accurately. Postoperative therapeutic effect was evaluated and divided into: immediate relief, delayed relief, relapse, and no relief.
ResultsIn 97 patients, the offending vessel was identified to be the anterior inferior cerebellar artery (AICA) in 59 cases, the posterior inferior cerebellar artery (PICA) in 3 cases, and the vertebral-basal artery in 35 cases including 8 cases of merely vertebra-basal artery, 24 cases of vertebral-basal artery combined with AICA and 3 cases of vertebral-basal artery combined with PICA. Immediate postoperative relief was achieved in 68 cases (70.1%). After operation, there were 13 cases of fever, 4 cases of hearing impairment, 2 cases of tinnitus, and 5 cases of transient facial paralysis. The median follow-up time of 97 patients was 9 months (1-19 months). The latest follow-up showed that 93 patients (95.9%) reported complete disappearance of facial spasm, among which 25 achieved delayed relief, and there were 4 cases reporting no relief. There were no cases of recurrence.
ConclusionEndoscopic microvascular decompression via retrosigmoid infrafloccular approach could not only improve the relief rate of hemifacial spasm, but also help decrease the incidence of postoperative complications.
Key words:
Hemifacial spasm; Natural orifice endoscopic surgery; Microvascular decom-pression; Retrosigmoid infrafloccular approach
Contributor Information
Ma Xiangyu
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Institute of Shandong University, Jinan 250012, China
Guo Xing
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Institute of Shandong University, Jinan 250012, China
Zhang Chao
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Institute of Shandong University, Jinan 250012, China
Li Yuexuan
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Institute of Shandong University, Jinan 250012, China
Xu Shujun
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Institute of Shandong University, Jinan 250012, China
Ni Shilei
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Institute of Shandong University, Jinan 250012, China
Li Xin′gang
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Institute of Shandong University, Jinan 250012, China
Li Weiguo
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Institute of Shandong University, Jinan 250012, China
