Abstract
Background
Multiple vessels from the anterior inferior cerebellar artery–posterior inferior cerebellar artery common trunk (APC) variation of the posterior circulation can cause hemifacial spasm (HFS).
Method
Endoscopic microvascular decompression (eMVD) was performed using 0° and 30° endoscopes through a retrosigmoid keyhole. The root exit zone (REZ) was decompressed by transpositioning the offending anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) arising from the APC under excellent endoscopic view.
Conclusion
eMVD is an advanced, minimally invasive and reliable technique to resolve the neurovascular conflict (NVC) in HFS due to offenders from APC.
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References
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Contributions
Afsal Sharafudeen collected the data, analyzed it, and wrote the manuscript. Fuminari Komatsu collected the data and reviewed the manuscript and supervised the findings of this work. Kantenga Dieu Merci Kabulo collected and analyzed of the results. Yoko Kato supervised the findings of this work. All authors reviewed the results and approved the final version of the manuscript.
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The institutional ethics committee approved this study and the study was conducted in accordance with the guidelines of the 1964 Declaration of Helsinki.
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Key points.
• Preoperative assessment and planning with the help of 3D Fusion images from MRI and CTA.
• Optimal patient positioning and accurate placement of retrosigmoid keyhole.
• Gentle advancing to the CPA draining CSF sufficiently after sharp dissection of arachnoid mater around jugular foramen.
• Use of patties on the cerebellar surface as cushioning to avoid injury.
• Use of a pneumatic arm to hold the endoscope.
• Use of single shaft instruments that are malleable.
• Use of angled endoscopes for a splendid visualization of structures around CN VII, which is limited in conventional microscopic approach.
• Continuous BAEP monitoring.
• Transpositioning using fibrin glue rather than interpositioning with teflon if possible.
• Intraoperative ICG angiography use before and after decompression.
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Sharafudeen, A., Komatsu, F., Kabulo, K.D.M. et al. How I do it: endoscopic microvascular decompression for hemifacial spasm associated with anterior inferior cerebellar artery–posterior inferior cerebellar artery common trunk. Acta Neurochir 166, 49 (2024). https://doi.org/10.1007/s00701-024-05963-w
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DOI: https://doi.org/10.1007/s00701-024-05963-w