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  • Title: Hemifacial spasm: neurovascular compressive patterns and surgical significance.
    Author: Park JS, Kong DS, Lee JA, Park K.
    Journal: Acta Neurochir (Wien); 2008 Mar; 150(3):235-41; discussion 241. PubMed ID: 18297233.
    Abstract:
    BACKGROUND: The aim of this study was to report further investigation of neurovascular compression as a cause of hemifacial spasm (HFS) and to provide useful surgical guidelines by describing the compression patterns. MATERIAL AND METHODS: From January 2004 to February 2006, 236 consecutive patients with HFS underwent microvascular decompression (MVD) in a single centre. Based on the operation and medical records, the intraoperative findings and post-operative outcomes were obtained and analysed. RESULTS: We found that 95.3% of lesions had accompanying causative factors that made the neurovascular compression inevitable. Based on the contributing factors, compression patterns were categorised into six different types including: loop (n = 11: 4.6%), arachnoid (n = 66: 27.9%), perforator (n = 58: 24.6%), branch (n = 18: 7.6%), sandwich (n = 28: 11.9%), and tandem (n = 52: 22.0%). The compression patterns were significantly correlated with the compressing vessels involved. Thirty-two (86.5%) of 37 lesions where the vertebral artery was the compressing vessel involved the tandem type. Anterior inferior cerebellar artery was the compressing vessel involved in 49 (84.5%) of 58 perforator type compressions, while posterior inferior cerebellar artery was the compressing vessel involved in 8 (72.7%) of 11 loop type compressions. CONCLUSIONS: Once the compressing vessel responsible for the neurovascular compression are identified, the probable pattern of compression can be anticipated; this knowledge could facilitate the application of the appropriate operative procedures and minimise post-operative complications.
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