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Microvascular decompression under neuroendoscopic view in hemifacial spasm: rostral-type compression and perforator-type compression

Abstract

We report microvascular decompression (MVD) under neuroendoscopic view in hemifacial spasm (HFS) patients with rostral- and perforator-type compression of the root exit zone (REZ) of the facial nerve. Using either a wireless iPad Mini as a monitor on the microscope or a high-resolution monitor, microscopic and endoscopic views enabled MVD for complete cure of HFS with rostral-type compression (the offender compressing the REZ on the opposite rostral side to the operative approach) or perforator-type compression (the offender tethered to the REZ by the perforator). MVD under neuroendoscopic view may offer more accurate MVD and complete resolution of HFS.

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Conflict of interest

None.

Author information

Correspondence to Mami Ishikawa.

Additional information

Comment

The role of endoscopy in microvascular decompression (MVD) is currently not well defined. Visualization of neurovascular conflicts at the level of the CPA is a key factor for a satisfactory outcome of the procedure whether the procedure is done for HFS, TGN, or other conditions.

Traditional approaches are based on a standard exposure of the CPA with CFS release and visualization of the upper, middle, or lower CPA complex (depending on the indication for the MVD).

At times, the compression is "around the corner" and endoscopic instruments allow a better visualization of the conflict, as the authors have clearly described in this article. There are still limitations of the technique, mainly in relation to the limited anatomical space and the complexity of the surgical anatomy. Endoscopy is a useful adjunction to the surgical "armamentarium" of neurosurgeons performing MVD.

Jibril Osman Farah

Liverpool, UK

Sandell T, Ringstad GA, Eide PK (2014)Usefulness of the endoscope in microvascular decompression for trigeminal neuralgia and MRI-based prediction of the need for endoscopy. Acta Neurochir (Wien) 156(10):1901-9

Setty P, Volkov AA, D'Andrea KP, Pieper DR (2014) Endoscopic vascular decompression for the treatment of trigeminal neuralgia: clinical outcomes and technical note. World Neurosurg 81(3-4):603-8.

The authors have no personal or institutional interest in any of the drugs, materials, or devices described in this article.

Electronic supplementary material

Below is the link to the electronic supplementary material.

The author performing the operation under microscopic and neuroendoscopic views with the wireless iPad Mini monitor on the microscope. (video) (WMV 14.2 MB)

Microscopic and neuroendoscopic views during MVD in the patient with HFS caused by rostral-type compression (patient 1, Fig. 1b) (MPG 7246 kb)

ESM 1

The author performing the operation under microscopic and neuroendoscopic views with the wireless iPad Mini monitor on the microscope. (video) (WMV 14.2 MB)

ESM 2

Microscopic and neuroendoscopic views during MVD in the patient with HFS caused by rostral-type compression (patient 1, Fig. 1b) (MPG 7246 kb)

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Ishikawa, M., Tanaka, Y. & Watanabe, E. Microvascular decompression under neuroendoscopic view in hemifacial spasm: rostral-type compression and perforator-type compression. Acta Neurochir 157, 329–332 (2015). https://doi.org/10.1007/s00701-014-2294-3

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Keywords

  • Hemifacial spasm
  • Electrophysiology
  • Endoscope
  • Microvascular decompression