Application of neuroendoscopy in the surgical treatment of complicated hemifacial spasm

OBJECTIVE: To explore the value of neuroendoscopy in surgery for primary hemifacial spasm (HFS) in patients with complicated local anatomy. METHODS: Endoscopic-assisted microvascular decompression (MVD) was performed in 42 patients with HFS with complicated local anatomy from January 2008 to January 2012 in our department, in the event of a significant blind spot, endoscopic exploration was performed with multi-angle 360-degree observation, including exploration of the brainstem facial nerve root exit zone (REZ) and exploration of the distal end of the nerve, and the relationships between blood vessels and nerves were carefully determined. After surgery, endoscopic examination was performed again to rule out vascular omissions, avascular excessive stretch, kinking, or formation of new compressions. The relevant data of all cases were retrospectively analyzed. RESULTS: All patients were followed for 18-30 months, 41 patients had complete remission without recurrence (97.6%), 3 cases recovered to grade 0 from discharge grade I, 1 case of hearing loss was fully restored in 6 months, and 1 case of grade II was not significant increased to the end of follow-up. CONCLUSIONS: Neuroendoscopy is an effective supplement to traditional MVD in treating HFS. In particular, in patients with complicated or abnormal local anatomy (for example small posterior fossa volume, abnormal fullness of the cerebellar flocculus, petrous bone block, local thickening of arachnoid adhesions, and unidentified offending vessels), neuroendoscopy can greatly improve the effectiveness of surgery.