title: Supine No-Retractor Method in Microvascular Decompression for Hemifacial Spasm: Results of 100 Consecutive Operations.
abstract: Objectives In microvascular decompression (MVD) for hemifacial spasm (HFS), the patient is placed in the lateral or park-bench position that is complicated and uncomfortable for anesthesiologists, nurses, and even the patient. Careless retraction of the cerebellum by a spatula could be the major cause of surgical complications. In our method, a patient is laid supine avoiding the complicated positioning. The subfloccular approach from a small cranial window sited on the more lateral and basal side of the occipital cranium enables the surgeon to reach all the segments of the facial nerve root without a spatula. We introduce our surgical procedures in detail along with our excellent results. Methods A total of 100 consecutive patients experiencing primary HFS were operated on with MVD by a single surgeon in our institution from August 2012 to April 2014. Results Overall, 94 patients showed the complete disappearance or a satisfactory alleviation of HFS. De novo neurologic deficits were not encountered after surgery including hearing impairment. In 47 cases, multiple offending vessels were observed in multiple possible affected sites in addition to the root entry/exit zone. Conclusions We believe this approach is superior for the safe and precise decompression of any part of the facial nerve root.
authors.affiliation: Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Shimizu
authors.affiliation: Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Wada
authors.affiliation: Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Sugiyama
authors.affiliation: Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tanioka
authors.affiliation: Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Okumura
authors.affiliation: Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Hirotake
authors.initials: H
authors.lastname: Fujishima
authors.affiliation: Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Takato
authors.initials: T
authors.lastname: Nakajo
authors.affiliation: Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Nakayama
authors.affiliation: Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Yabuzaki
authors.affiliation: Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Tohoru
authors.initials: T
authors.lastname: Mizutani
keywords: hemifacial spasm; microvascular decompression; no retractor; supine position