PMID- 29617905
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20191120
IS  - 2332-4260 (Electronic)
IS  - 2332-4252 (Linking)
VI  - 16
IP  - 1
DP  - 2019 Jan 1
TI  - Microvascular Decompression of Facial Nerve and Pexy of the Left Vertebral Artery 
      for Left Hemifacial Spasm: 3-Dimensional Operative Video.
PG  - E2-E3
LID - 10.1093/ons/opy058 [doi]
AB  - A 73-yr-old man presented with intractable left hemifacial spasm of 4 yr 
      duration. Brain magnetic resonance imaging showed significant compression of left 
      facial nerve by the left vertebral artery (VA) and anterior inferior cerebellar 
      artery (AICA).The patient underwent a left retrosigmoid craniotomy and a 
      microvascular decompression of the cranial nerve (CN) VII. Intraoperatively, we 
      found that the distal AICA had a protracted subarcuate extradural course.1 This 
      was relieved by intra/extradural dissection. The left VA and the AICA loop were 
      compressing the root exit zone of CN VII. The VA was mobilized, and pexy into the 
      petrosal dura was done with 8-0 nylon sutures (Ethilon Nylon Suture, Ethicon Inc, 
      a subsidiary of Johnson & Johnson, Somerville, New Jersey). Once this was done, 
      the lateral spread disappeared.2 The AICA loop was decompressed with 2 pieces of 
      Teflon felt (Bard PTFE felt, Bard peripheral Vascular Inc, a subsidiary of CR 
      Bard Inc, Temp, Arizona). After this, wave V of the brainstem auditory evoked 
      potential (BAEP) disappeared completely, with no recovery despite the application 
      of the nicardipine on the internal auditory artery (IAA). The IAA appeared to be 
      stretched by the microvascular decompression. Arachnoidal dissection was done to 
      release the CN VIII and an additional felt piece was placed to elevate the AICA 
      loop; the BAEP recovered completely. The patient had a complete disappearance of 
      the hemifacial spasm postoperatively, and hearing was unchanged.This 3-D video 
      shows the technical nuances of performing a vertebropexy, release of the AICA 
      from its extradural subarcuate course, and the surgical maneuvers in the event of 
      an unexpected change in neuromonitoring response. The suture technique of 
      vertebropexy is preferred to a loop technique, to avoid kinking of the 
      VA.3Informed consent was obtained from the patient prior to the surgery that 
      included videotaping of the procedure and its distribution for educational 
      purposes. All relevant patient identifiers have also been removed from the video 
      and accompanying radiology slides.
FAU - Cheng, Chun-Yu
AU  - Cheng CY
AD  - Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
AD  - College of Medicine, Chang Gung University, Taoyuan, Taiwan.
AD  - Department of Neurosurgery, University of Washington, Seattle, Washington.
FAU - Shetty, Rakshith
AU  - Shetty R
AD  - Department of Neurosurgery, University of Washington, Seattle, Washington.
FAU - Martinez, Vicente
AU  - Martinez V
AD  - Department of Rehabilitation Medicine, University of Washington, Seattle, 
      Washington.
FAU - Sekhar, Laligam N
AU  - Sekhar LN
AD  - Department of Neurosurgery, University of Washington, Seattle, Washington.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Oper Neurosurg (Hagerstown)
JT  - Operative neurosurgery (Hagerstown, Md.)
JID - 101635417
SB  - IM
EDAT- 2018/04/05 06:00
MHDA- 2018/04/05 06:01
CRDT- 2018/04/05 06:00
PHST- 2018/04/05 06:00 [pubmed]
PHST- 2018/04/05 06:01 [medline]
PHST- 2018/04/05 06:00 [entrez]
AID - 4956238 [pii]
AID - 10.1093/ons/opy058 [doi]
PST - ppublish
SO  - Oper Neurosurg (Hagerstown). 2019 Jan 1;16(1):E2-E3. doi: 10.1093/ons/opy058.