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Microvascular decompression for hemifacial spasm involving the vertebral artery

OBJECTIVE: Microvascular decompression (MVD) has become an accepted treatment modality for the vertebral artery (VA)–involved hemifacial spasm (HFS). The aim of this retrospective study was to evaluate clinical and surgical outcomes of HFS patients undergoing MVD and surgical and cranial nerve compl...

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Autores principales: Wang, Jing, Chong, Yulong, Jiang, Chengrong, Dai, Yuxiang, Liang, Weibang, Ding, Lianshu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8913562/
https://www.ncbi.nlm.nih.gov/pubmed/34870744
http://dx.doi.org/10.1007/s00701-021-05076-8
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author Wang, Jing
Chong, Yulong
Jiang, Chengrong
Dai, Yuxiang
Liang, Weibang
Ding, Lianshu
author_facet Wang, Jing
Chong, Yulong
Jiang, Chengrong
Dai, Yuxiang
Liang, Weibang
Ding, Lianshu
author_sort Wang, Jing
collection PubMed
description OBJECTIVE: Microvascular decompression (MVD) has become an accepted treatment modality for the vertebral artery (VA)–involved hemifacial spasm (HFS). The aim of this retrospective study was to evaluate clinical and surgical outcomes of HFS patients undergoing MVD and surgical and cranial nerve complications and investigate reasonable transposition procedures for two different anatomic variations of VA. METHODS: Between January and December 2018, 109 patients underwent first MVD for HFS involving VA at Nanjing Drum Tower Hospital. Based on whether the VA could be moved ventrally at the lower cranial nerves (LCNs) level, patients were assigned to Group A (movable VA, n = 72) or B (unmovable VA, n = 37), and clinical and surgical outcomes and complications on the day of post-surgery and during follow-up were assessed. All patients were followed up ranging from 17 to 24 months with a mean follow-up period of 21 months. RESULTS: After a mean follow-up of 21 months, the total cure rate significantly decreased in all patients compared to that achieved on the day of surgery, and Group A patients exhibited a higher cure rate versus Group B (93.1% vs. 75.7%, P = 0.015). Group B patients with unmovable VA revealed both higher incidence of surgical complications (45.9% vs. 15.3%, P = 0.001) and frequency of bilateral VA compression (27% vs. 8.3%, P = 0.009) versus Group A. No significant difference was observed in long-term cranial nerve complications. CONCLUSIONS: VA-involved HFS can benefit from MVD strategies after preoperative assessment of VA compression. HFS patients with movable VA may receive better long-term efficacy and fewer complications. A Teflon bridge wedged between the distal VA and medulla gives rise to adequate space for decompression surgery.
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spelling pubmed-89135622022-03-17 Microvascular decompression for hemifacial spasm involving the vertebral artery Wang, Jing Chong, Yulong Jiang, Chengrong Dai, Yuxiang Liang, Weibang Ding, Lianshu Acta Neurochir (Wien) Original Article - Functional Neurosurgery - Movement disorders OBJECTIVE: Microvascular decompression (MVD) has become an accepted treatment modality for the vertebral artery (VA)–involved hemifacial spasm (HFS). The aim of this retrospective study was to evaluate clinical and surgical outcomes of HFS patients undergoing MVD and surgical and cranial nerve complications and investigate reasonable transposition procedures for two different anatomic variations of VA. METHODS: Between January and December 2018, 109 patients underwent first MVD for HFS involving VA at Nanjing Drum Tower Hospital. Based on whether the VA could be moved ventrally at the lower cranial nerves (LCNs) level, patients were assigned to Group A (movable VA, n = 72) or B (unmovable VA, n = 37), and clinical and surgical outcomes and complications on the day of post-surgery and during follow-up were assessed. All patients were followed up ranging from 17 to 24 months with a mean follow-up period of 21 months. RESULTS: After a mean follow-up of 21 months, the total cure rate significantly decreased in all patients compared to that achieved on the day of surgery, and Group A patients exhibited a higher cure rate versus Group B (93.1% vs. 75.7%, P = 0.015). Group B patients with unmovable VA revealed both higher incidence of surgical complications (45.9% vs. 15.3%, P = 0.001) and frequency of bilateral VA compression (27% vs. 8.3%, P = 0.009) versus Group A. No significant difference was observed in long-term cranial nerve complications. CONCLUSIONS: VA-involved HFS can benefit from MVD strategies after preoperative assessment of VA compression. HFS patients with movable VA may receive better long-term efficacy and fewer complications. A Teflon bridge wedged between the distal VA and medulla gives rise to adequate space for decompression surgery. Springer Vienna 2021-12-06 2022 /pmc/articles/PMC8913562/ /pubmed/34870744 http://dx.doi.org/10.1007/s00701-021-05076-8 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article - Functional Neurosurgery - Movement disorders
Wang, Jing
Chong, Yulong
Jiang, Chengrong
Dai, Yuxiang
Liang, Weibang
Ding, Lianshu
Microvascular decompression for hemifacial spasm involving the vertebral artery
title Microvascular decompression for hemifacial spasm involving the vertebral artery
title_full Microvascular decompression for hemifacial spasm involving the vertebral artery
title_fullStr Microvascular decompression for hemifacial spasm involving the vertebral artery
title_full_unstemmed Microvascular decompression for hemifacial spasm involving the vertebral artery
title_short Microvascular decompression for hemifacial spasm involving the vertebral artery
title_sort microvascular decompression for hemifacial spasm involving the vertebral artery
topic Original Article - Functional Neurosurgery - Movement disorders
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8913562/
https://www.ncbi.nlm.nih.gov/pubmed/34870744
http://dx.doi.org/10.1007/s00701-021-05076-8
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