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Indication for a skull base approach in microvascular decompression for hemifacial spasm

  • Original Article - Neurosurgical technique evaluation
  • Published:
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Abstract

Background

A thorough observation of the root exit zone (REZ) and secure transposition of the offending arteries is crucial for a successful microvascular decompression (MVD) for hemifacial spasm (HFS). Decompression procedures are not always feasible in a narrow operative field through a retrosigmoid approach. In such instances, extending the craniectomy laterally is useful in accomplishing the procedure safely. This study aims to introduce the benefits of a skull base approach in MVD for HFS.

Methods

The skull base approach was performed in twenty-eight patients among 335 consecutive MVDs for HFS. The site of the neurovascular compression (NVC), the size of the flocculus, and the location of the sigmoid sinus are measured factors in the imaging studies. The indication for a skull base approach is evaluated and verified retrospectively in comparison with the conventional retrosigmoid approach. Operative outcomes and long-term results were analyzed retrospectively.

Results

The extended retrosigmoid approach was used for 27 patients and the retrolabyrinthine presigmoid approach was used in one patient. The measurement value including the site of NVC, the size of the flocculus, and the location of the sigmoid sinus represents well the indication of the skull base approach, which is significantly different from the conventional retrosigmoid approach. The skull base approach is useful for patients with medially located NVC, a large flocculus, or repeat MVD cases. The long-term result demonstrated favorable outcomes in patients with the skull base approach applied.

Conclusions

Preoperative evaluation for lateral expansion of the craniectomy contributes to a safe and secure MVD.

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Acknowledgements

We thank Ms. Satomi Fujimura, Ms. Yasuko Noda, and Ms. Kayoko Kutsuwa for their assistance with data collection and illustrations.

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Authors and Affiliations

  1. Department of Neurosurgery, Subarukai Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, 527-0134, Shiga, Japan

    Takuro Inoue, Yukihiro Goto & Satoshi Shitara

  2. Department of Neurosurgery, Indonesia National Brain Center Hospital, East Jakarta, Special Capital Region of Jakarta, Indonesia

    Takuro Inoue, Ryan Keswani, Mustaqim Prasetya & Abrar Arham

  3. Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan

    Kenichiro Kikuta

  4. Raleigh Neurosurgical Clinic, Raleigh, NC, USA

    Lori Radcliffe

  5. Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Allan H. Friedman & Takanori Fukushima

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  1. Takuro Inoue
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  2. Yukihiro Goto
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  3. Satoshi Shitara
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  10. Takanori Fukushima
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Corresponding author

Correspondence to Takuro Inoue.

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Inoue, T., Goto, Y., Shitara, S. et al. Indication for a skull base approach in microvascular decompression for hemifacial spasm. Acta Neurochir 164, 3235–3246 (2022). https://doi.org/10.1007/s00701-022-05397-2

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  • DOI: https://doi.org/10.1007/s00701-022-05397-2

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