[Results of treatment of hemifacial spasm by surgical and endoscopic neurovascular decompression. Analysis of 60 records].
The notion of a neurovascular conflict in the pathogenesis of hemifacial spasm is now well accepted based on evidence obtained from pre-operative imaging and per-operative videoendoscopy of the pontocerebellous angle. We operated 60 patients, 47 women and 13 men, age range 28-79 years, who had hemifacial spasms for 2 months to 30 years. Neurovascular decompression of the facial nerve via the retrosigmoid access was performed using a minimal invasive technique: limited access of short duration, microsurgery, endoscopic and electrophysiologic techniques, positioning of Teflon microsponges between the nerve and the vessels involved. Surgery led to 90% good long-term results with minimal morbidity limited to auditive sequellae in 3.3% of the cases. The site of compression was at the point where the facial nerve emerged in 95% of the cases. Arteries involved were the posteroinferior cerebellous artery (39 cases), the vertebral artery (23 cases) and the anteroinferior cerebellous artery (16 cases). In a third of the cases, the vascular conflict involved more than one vessel. The facial nerve should be isolated from any nociceptive contact to obtain definitive cure.
Cacès
F
F
Service d'ORL et de Chirurgie Cervico-Faciale, CHU Nord Chemin des Bourrelys, Marseille.
Chays
A
A
Magnan
J
J
D000328:Adult; D000368:Aged; D002530:Cerebellopontine Angle / Q000098:blood supply*; D004724:Endoscopy; D005152:Facial Muscles / Q000503:physiopathology* / Q000601:surgery; D005155:Facial Nerve Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D013035:Spasm / Q000601:surgery*; D016896:Treatment Outcome