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.
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Funding
The project was supported by the National Science Foundation of China (grant no. 8117116), a grant from the Health Commission of Shanghai (grant no. XBR2011034), and two grants from the Science and Technology Commission of Shanghai (grant nos. 134119a9400 and 14DZ1930303).
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Comment
The authors operated on an impressive series of 2,576 cases of facial hemispasm. In 4 of these 2,576 patients (0.15 %) they found a vessel (artery n = 3, vein n = 1) running through the facial nerve, probably causing the symptoms. By wrapping the artery using wet gelatin and Teflon sponge and by combing the nerve in the single case of an offending vein, they achieved good to excellent results. One patient experienced a facial paresis. Given the incidence of 0.15 %, the chance that the average neurosurgeon is confronted with the situation of a vessel running through the facial nerve in facial hemispasm is extremely low. Thus, despite being only a small case series, it is helpful that the authors share their abundant expertise and offer the average neurosurgeon solutions for these rare situations.
Veit Rohde
Göttingen, Germany
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Feng, BH., Zheng, XS., Wang, XH. et al. Management of vessels passing through the facial nerve in the treatment of hemifacial spasm. Acta Neurochir 157, 1935–1940 (2015). https://doi.org/10.1007/s00701-015-2562-x
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DOI: https://doi.org/10.1007/s00701-015-2562-x