Management of vessels passing through the facial nerve in the treatment of hemifacial spasm.
BACKGROUND
In hemifacial spasm, it is extremely rare to find a vessel passing through the facial nerve. In this study, we present our experience of the surgical treatment of four such patients.


METHODS
From January 2010 to Match 2015, we treated 2,576 hemifacial spasm patients with microvascular decompression in our department. Of these, four had an intraneural vessel. Intraoperative findings and treatment were recorded, and postoperative outcomes were analyzed.


RESULTS
In three patients, the intraneural vessel was the anterior inferior cerebellar artery, which we wrapped with small pieces of wet gelatin and Teflon sponge. A small vein found in the fourth patient was treated with facial nerve combing. Complete decompression was achieved and abnormal muscle response disappeared. Three patients got an excellent result and one patient got a good result. One patient had postoperative facial paralysis, which improved over 10 months of follow-up.


CONCLUSIONS
If an artery passes through the facial nerve, it can be decompressed by wrapping the vessel with wet gelatin and Teflon sponge. If a vein passes through the facial nerve, combing can be used. Intraoperative abnormal muscle response monitoring is very helpful in achieving complete decompression.
Department of Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, 200092, China.
Bao-Hui
BH
Feng
Department of Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, 200092, China.
Xue-Sheng
XS
Zheng
Department of Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, 200092, China.
Xu-Hui
XH
Wang
Department of Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, 200092, China.
Ting-Ting
TT
Ying
Department of Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, 200092, China.
Min
M
Yang
Department of Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, 200092, China.
Yin-Da
YD
Tang
Department of Neurosurgery, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Cranial Nerve Disease Center of Shanghai JiaoTong University, Shanghai, 200092, China. xinhuaneuro@163.com.
Shi-Ting
ST
Li
D000328:Adult; D000368:Aged; D005154:Facial Nerve / Q000098:blood supply / Q000601:surgery*; D005158:Facial Paralysis / Q000209:etiology*; D005260:Female; D019569:Hemifacial Spasm / Q000601:surgery*; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged
Electrophysiological monitoring; Hemifacial spasm; Intraneural vessel; Microvascular decompression