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Microvascular decompression of the facial nerve for the treatment of hemifacial spasm: preoperative magnetic resonance imaging related to clinical outcomes.

Authors
 S. S. Chung  ;  J. W. Chang  ;  S. H. Kim  ;  J. H. Chang  ;  Y. G. Park  ;  D. I. Kim 
Citation
 Acta Neurochirurgica, Vol.142(8) : 901-907, 2000 
Journal Title
 Acta Neurochirurgica 
ISSN
 0001-6268 
Issue Date
2000
MeSH
Adult ; Aged ; Case-Control Studies ; Cerebral Arteries/pathology* ; Cerebral Arteries/surgery ; Decompression, Surgical*/methods ; Diagnosis, Differential ; Facial Nerve/pathology* ; Female ; Hemifacial Spasm/diagnosis* ; Hemifacial Spasm/surgery* ; Humans ; Magnetic Resonance Angiography* ; Male ; Microsurgery ; Middle Aged ; Preoperative Care ; Proportional Hazards Models ; Retrospective Studies ; Survival Analysis ; Treatment Outcome ; Vascular Surgical Procedures/methods ; Vertebral Artery/pathology* ; Vertebral Artery/surgery
Keywords
Hemifacial spasm ; microvascular decompression ; magnetic resonance angiography ; facial nerve
Abstract
BACKGROUND: The objective of this study was to investigate the role of preoperative three dimensional short-range magnetic resonance angiography (3D-TOF MRA) in predicting the clinical outcomes following microvascular decompression for the treatment of hemifacial spasm. METHOD: Preoperative magnetic resonance (MR) imaging was performed on all patients with hemifacial spasm (564 cases) between January 1992 and September 1998. Of the 564 patients, 440 patients were included in this retrospective study. The presence of vascular contact, offenders, and anomalies in the vertebro-basilar system, were determined by 3D-TOF MRA prior to microvascular decompression of the facial nerve. The preoperative findings were compared with the surgical findings and clinical outcomes. Findings. A correlation was found between the clinical outcome (p < 0.01) and the presence of a vascular indentation at the root entry zone (REZ) of the facial nerve. A shift of the vertebrobasilar system to the symptomatic side was found in 214 (48.6%) patients with hemifacial spasm, compared to only 10 (13.5%) patients in the control group (p < 0.01). The unilateral vertebral artery was observed in 43 (9.8%) patients with hemifacial spasm and in 8 (10.8%) of the control patients. A hypoplasia of the artery was found in 8 (1.8%) patients with hemifacial spasm and in 1 (1.4%) control patient. The compressing offenders in the patients, discovered by MRI in conjunction with MRA, were as follows: 45.9% (202 patients) in the anterior inferior cerebellar artery (AICA), 34.8% (153 patients) in the posterior inferior cerebellar artery (PICA), 12.5% (55 patients) in the vertebral artery (VA) and 6.8% (30 patients) in multiple vessels. In contrast to the compressing offenders seen on the MRA, the offenders confirmed during surgery were as follows: 43% (189 patients) in the AICA, 36.4% (160 patients) in the PICA, 1.4% (6 patients) in the VA, 19% (84 patients) in multiple vessels, and 0.2% (1 patient) in the vein. In our long-term follow-up series of the 440 patients with hemifacial spasm, an excellent surgical outcome was obtained in 86.3% of cases and a good outcome was achieved in 6.4% (mean follow-up duration, 45.5 months). INTERPRETATION: Preoperative 3D-TOF MRA can identify the relationship between the facial nerve and adjacent vessels in patients with a hemifacial spasm and assist in preoperative planning. This study suggests that 3D-TOF MRA is useful for selecting appropriate patients for surgical treatment and, to some extent, as an additional role for predicting the clinical outcome.
Full Text
https://link.springer.com/article/10.1007%2Fs007010070076
DOI
10.1007/s007010070076
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Park, Yong Gou(박용구)
Chang, Jong Hee(장종희) ORCID logo https://orcid.org/0000-0003-1509-9800
Chang, Jin Woo(장진우) ORCID logo https://orcid.org/0000-0002-2717-0101
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/171523
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