Fully Endoscopic Microvascular Decompression for Hemifacial Spasm: A Clinical Study and Analysis

Abstract

Abstract Objective: Fully endoscopic microvascular decompression of the facial nerve is a pivotal surgical approach for treating hemifacial spasm. However, it presents distinct surgical challenges and necessitates a learning curve. Hence, this study aimed to consolidate surgical insights and assess clinical outcomes based on a retrospective analysis of prior cases. Methods: Clinical data from 16 patients with facial nerve spasms treated at the Department of Neurosurgery in the First Affiliated Hospital of Bengbu Medical College, between August 2020 and July 2023, were retrospectively examined. Preoperatively, all patients underwent magnetic resonance angiography to confirm the presence or absence of responsible blood vessels, ascertain the relationship between responsible blood vessels, facial nerves, and brainstem, and detect any cerebellopontine angle lesions. The surgical technique encompassed entirely endoscopic microvascular decompression of the facial nerve, employing a mini sigmoid sinus posterior approach. The operative nuances and clinical efficacy were summarized and analyzed. The former encompassed intraoperative positioning, incision design, bone window parameters, mirror-handling methodology, crucial points of collaboration between the surgeon and assistant, and intraoperative management of responsible blood vessels. The latter included typical postoperative complications and the extent of relief from facial paralysis. Results: All 16 patients successfully underwent the procedure, with the responsible blood vessels identified and adequately padded during surgery. These comprised 12 cases of anterior inferior cerebellar artery (75%), 3 cases of vertebral artery (18.75%), and 1 case of posterior inferior cerebellar artery (6.25%). Intraoperative electrophysiological monitoring of lateral spread response of the facial nerve entirely vanished in 15 cases and remained unchanged in 1 case. Postoperative facial spasms were promptly alleviated in 15 cases (93.75%) and delayed in 1 case (6.25%). Two cases of postoperative complications were recorded; one instance of intracranial infection, which resolved following lumbar cistern external drainage and anti-infective treatment, and one case of tinnitus, mitigated through oral administration of mecobalamin and nimodipine. All patients were subject to follow-up, with no instances of recurrence or mortality. Conclusion: Complete endoscopic microvascular decompression of the facial nerve proves to be both safe and effective. Proficiency in endoscopy and surgical skills are pivotal, thereby discouraging novices in endoscopy from performing this procedure.