J Neurol Surg B Skull Base 2024; 85(S 01): S1-S398
DOI: 10.1055/s-0044-1780260
Presentation Abstracts
Poster Abstracts

Hemifacial Spasm with Offending Artery Penetrate the Facial Nerve: Surgical Technique and Prognosis

Authors

  • Hyunseok Lee

    1   Konkuk University Medical Center, Seoul, South Korea
  • Kwan Park

    1   Konkuk University Medical Center, Seoul, South Korea
 

In hemifacial spasm (HFS), there are various patterns of vascular compression of the facial nerve, including very rare form that offending vessel penetrates the facial nerve. Yet, there have been few reports on surgical techniques and postoperative prognosis.

A retrospective review of 4755 patients who underwent microvascular decompression (MVD. surgery from April 1997 to June 2023. 8 of 4,755 patients (0.2%) had a penetrating offending vessel, and these eight were analyzed with medical and surgical records. Surgery attempted to maximally decompress the penetrating offender.

Seven of the eight patients (87.5%) were spasm free immediately after surgery, and one had only 10% residual spasm compared to preoperatively. That one patient was also spasm-free one year later. Postoperative facial palsy occurred in 1 patient (12.5%) with House–Brackmann grade II. In one patient, resection of a small facial nerve bundle did not result in facial palsy. There were no cases of hearing loss or other complications.

Decompressing the penetrating offender did not increase the incidence of facial, and the prognosis for facial spasm was good. Therefore, when a penetrating pattern is encountered during MVD surgery, decompression between penetrating offender and the facial nerve may have good result.

Branch of anterior inferior cerebellar artery (AICA) pass through the facial nerve (orange circle).

Zoom

Decompression done with small Teflon felt, between penetrating vessel and facial nerve (white circle) and the LSR disappeared after decompression.

Zoom


Publication History

Article published online:
05 February 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany