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Wedge-technique for transposition of the vertebral artery in microvascular decompression for hemifacial spasm: technical nuances and surgical outcomes

  • Technical Note - Functional Neurosurgery - Other
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Abstract

Background

Transposition of the vertebral artery (VA) for microvascular decompression for hemifacial spasm (HFS) is often challenging. Various procedures have been proposed to transpose the immobile tortuous VA that cannot be decompressed satisfactorily in the usual manner.

Methods

A Teflon piece that is cut into a wedge shape was used for transposition of the VA as an offending artery in HFS. One or more wedge-shaped Teflon pieces were simply inserted into a small space between the VA and the brainstem or cerebellar hemisphere without any contact with the entry into the root exit zone (REZ) of the facial nerve. A minimal space can be created by slight mobilization of the VA through rostral or caudal, or in between to the lower cranial nerves (LCNs). In cases of a hypertrophic VA that is hard to mobilize, two or more rigid wedge-shaped Teflon pieces that are coated by fibrin glue can be applied to obtain adequate mobilization of the VA. Moreover, a much harder Teflon bar, which is bent into a V shape, can be used in cases of an immobile VA. Once the VA is transposed to an appropriate position, the Teflon, VA, and contacted surface of the brainstem are fixed together by drops of fibrin glue.

Results

The offending arteries were VA-posterior inferior cerebellar artery (PICA) in eight cases, VA in four cases, PICA in four cases, VA-anterior inferior cerebellar artery (AICA) in one case, and AICA in one case. Eighteen cases of HFS were successfully treated using the “Wedge technique.” Symptoms disappeared within 2 weeks in all patients. Transient facial nerve palsy developed in one case, and transient hoarseness developed in one case.

Conclusions

The wedge technique is a simple straight-line maneuver that facilitates sufficient transposition of the VA without any related complications. This technique is also useful for other large offending vessels, such as the anterior or posterior inferior cerebellar arteries, which are hard to mobilize due to the torque of the vessels.

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Abbreviations

ABR:

Auditory brainstem response

AICA:

Anterior inferior cerebellar artery

CPA:

Cerebellopontine angle

CSF:

Cerebrospinal fluid

HFS:

Hemifacial spasm

LCNs:

Lower cranial nerves

MVD:

Microvascular decompression

PICA:

Posterior inferior cerebellar artery

PTFE:

Polytetrafluoroethylene

REZ:

Root exit zone

TN:

Trigeminal neuralgia

VA:

Vertebral artery

VBA:

Vertebrobasilar artery

VBD:

Vertebrobasilar dolichoectasia

References

  1. Bejjani GK, Sekhar LN (1997) Repositioning of the vertebral artery as treatment for neurovascular compression syndromes. J Neurosurg 86:728–732

    Article  CAS  PubMed  Google Scholar 

  2. Ferreira M, Walcott BP, Nahed BV, Sekhar LN (2011) Vertebral artery pexy for microvascular decompression of the facial nerve in the treatment of hemifacial spasm. J Neurosurg 114:1800–1884. https://doi.org/10.3171/2010.12.JNS10891 Epub 2011 Jan 28

    Article  PubMed  Google Scholar 

  3. Fukushima T (1995) Microvascular decompression for hemifacial spasm: results of 2890 cases. In: Carter LP, Spetzler RF, Hamilton MG (eds) Neurovascular surgery. McGraw-Hill, New York, pp 1133–1147

    Google Scholar 

  4. Jannetta PJ, Abbasy M, Maroon JC, Ramos FM, Albin MS (1977) Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg 47:321–328

    Article  CAS  PubMed  Google Scholar 

  5. Ogawa A, Suzuki M, Shirane R, Yoshimoto T (1992) Repositioning of the tortuous vertebrobasilar artery for trigeminal neuralgia: a technical note. Surg Neurol 38:232–235

    Article  CAS  PubMed  Google Scholar 

  6. Otani N, Toyooka T, Fujii K, Kumagai K, Takeuchi S, Tomiyama A et al (2018) “Birdlime” technique using TachoSil tissue sealing sheet soaked with fibrin glue for sutures vessel transposition in microvascular decompression: operative technique and nuances. J Neurosurg 128:1522–1529

    Article  PubMed  Google Scholar 

  7. Premsagar IC, Moss T, Coakham HB (1997) Teflon-induced granuloma following treatment of trigeminal neuralgia by microvascular decompression. Report of two cases. J Neurosurg 87:454–457

    Article  CAS  PubMed  Google Scholar 

  8. Stone JL, Lichtor T, Crowell RM (1993) Microvascular sling decompression for trigeminal neuralgia secondary to ectatic vertebrobasilar compression. J Neurosurg 79:943–945

    Article  CAS  PubMed  Google Scholar 

  9. Takamiya Y, Toya S, Kawase T, Takenaka N, Shiga H (1985) Trigeminal neuralgia and hemifacial spasm caused by a tortuous vertebrobasilar system. Surg Neurol 24:559–562

    Article  CAS  PubMed  Google Scholar 

  10. Yoshimoto Y, Nogushi M, Tsutsumi Y (1995) Encircling method of trigeminal nerve decompression for neuralgia caused by tortuous vertebrobasilar artery: technical note. Surg Neurol 43:151–153

    Article  CAS  PubMed  Google Scholar 

  11. Zaidi HA, Awad AW, Chowdhry SA, Fusco D, Nakaji P, Spetzler RF (2015) Microvascular decompression for hemifacial spasm secondary to vertebrobasilar dolichoectasia: surgical strategies, technical nuances and clinical outcomes. J Clin Neurosci 22:62–68

    Article  PubMed  Google Scholar 

  12. Kyoshima K, Watanabe A, Toba Y, Nitta J, Muraoka S, Kobayashi S (1999) Anchoring method for hemifacial spasm associated with vertebral artery: technical note. Neurosurgery 45:1487–1491

    Article  CAS  PubMed  Google Scholar 

  13. Masuoka J, Matsushima T, Kawashima M, Nakahara Y, Funaki T, Mineta T (2011) Stitched sling retraction technique for microvascular decompression: procedures and techniques based on an anatomical viewpoint. Neurosurg Rev 34:373–379

    Article  PubMed  Google Scholar 

  14. Munich SA, Morcos JJ (2018) “Microvascular” decompression of dolichoectatic vertebral artery causing hemifacial spasm using Goretex sling: 2-dimensional operative video. Oper Neurosurg (Hagerstown) (May 22). https://doi.org/10.1093/ons/opy111 [Epub ahead of print]

  15. Shimano H, Kondo A, Yasuda S, Inoue H, Park YT, Murano K (2015) Microvascular decompression for hemifacial spasm associated with bilateral vertebral artery compression. World Neurosurg 84:1178.e5–1178.e9. https://doi.org/10.1016/J-wneu.2015.06.026 Epub 2015 Jun 20

    Article  Google Scholar 

  16. Suzuki S, Tsuchita H, Kurokawa Y, Kitami K, Sohma T, Takeda T (1990) New method of MVD using a vascular tape for neurovascular compression involving the vertebrobasilar artery-report of two cases. Neurol Med Chir (Tokyo) 30:1020–1023

    Article  CAS  Google Scholar 

  17. Tanaka Y, Uchida M, Onodera H, Hiramoto J, Yoshida Y (2014) Simple transposition technique for microvascular decompression using an expanded polytetrafluoroethylene “belt”: technical note. Neurol Med Chir (Tokyo) 54:483–485

    Article  Google Scholar 

  18. Fukushima T (1984) Results of posterior fossa microvascular decompression in the treatment of hemifacial spasm. Facial N Res Jpn 4:9–14 [Japanese]

  19. Fukushima T (1986) Operative treatment of hemifacial spasm. Clin Neurosci 4:112–113 [Japanese]

    Google Scholar 

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Correspondence to Yoichi Nonaka.

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Nonaka, Y., Hayashi, N., Matsumae, M. et al. Wedge-technique for transposition of the vertebral artery in microvascular decompression for hemifacial spasm: technical nuances and surgical outcomes. Acta Neurochir 161, 1435–1442 (2019). https://doi.org/10.1007/s00701-018-03793-1

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  • DOI: https://doi.org/10.1007/s00701-018-03793-1

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