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

Publication ,  Journal Article
Inoue, T; Goto, Y; Shitara, S; Keswani, R; Prasetya, M; Arham, A; Kikuta, K; Radcliffe, L; Friedman, AH; Fukushima, T
Published in: Acta Neurochir (Wien)
December 2022

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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Published In

Acta Neurochir (Wien)

DOI

EISSN

0942-0940

Publication Date

December 2022

Volume

164

Issue

12

Start / End Page

3235 / 3246

Location

Austria

Related Subject Headings

  • Treatment Outcome
  • Skull Base
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Microvascular Decompression Surgery
  • Humans
  • Hemifacial Spasm
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences
 

Citation

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Inoue, T., Goto, Y., Shitara, S., Keswani, R., Prasetya, M., Arham, A., … Fukushima, T. (2022). Indication for a skull base approach in microvascular decompression for hemifacial spasm. Acta Neurochir (Wien), 164(12), 3235–3246. https://doi.org/10.1007/s00701-022-05397-2
Inoue, Takuro, Yukihiro Goto, Satoshi Shitara, Ryan Keswani, Mustaqim Prasetya, Abrar Arham, Kenichiro Kikuta, Lori Radcliffe, Allan H. Friedman, and Takanori Fukushima. “Indication for a skull base approach in microvascular decompression for hemifacial spasm.Acta Neurochir (Wien) 164, no. 12 (December 2022): 3235–46. https://doi.org/10.1007/s00701-022-05397-2.
Inoue T, Goto Y, Shitara S, Keswani R, Prasetya M, Arham A, et al. Indication for a skull base approach in microvascular decompression for hemifacial spasm. Acta Neurochir (Wien). 2022 Dec;164(12):3235–46.
Inoue, Takuro, et al. “Indication for a skull base approach in microvascular decompression for hemifacial spasm.Acta Neurochir (Wien), vol. 164, no. 12, Dec. 2022, pp. 3235–46. Pubmed, doi:10.1007/s00701-022-05397-2.
Inoue T, Goto Y, Shitara S, Keswani R, Prasetya M, Arham A, Kikuta K, Radcliffe L, Friedman AH, Fukushima T. Indication for a skull base approach in microvascular decompression for hemifacial spasm. Acta Neurochir (Wien). 2022 Dec;164(12):3235–3246.
Journal cover image

Published In

Acta Neurochir (Wien)

DOI

EISSN

0942-0940

Publication Date

December 2022

Volume

164

Issue

12

Start / End Page

3235 / 3246

Location

Austria

Related Subject Headings

  • Treatment Outcome
  • Skull Base
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Microvascular Decompression Surgery
  • Humans
  • Hemifacial Spasm
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences