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Owashi E, Ohmura K, Shoda K, Yamada T, Kano K, Nakayama N, Iwama T. Comparison of transposition and interposition methods in microvascular decompression for hemifacial spasm: an analysis of 109 cases performed by a single surgeon in a single-center retrospective study. Acta Neurochir (Wien) 2024; 166:213. [PMID: 38740614 DOI: 10.1007/s00701-024-06111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Microvascular decompression (MVD), the standard surgical approach for hemifacial spasm (HFS), can be divided into the interposition and transposition methods. Although the risk of HFS recurrence following interposition has been reported, there is limited data comparing long-term outcomes between both methods performed by a single surgeon. This study aimed to investigate the efficacy of MVD techniques on HFS by comparing surgical outcomes performed by a single surgeon in a single-center setting. METHODS A total of 109 patients who underwent MVD were analyzed and divided into the transposition (86 patients) and interposition (23 patients) groups. Postoperative outcomes at 1 month and 1 year were assessed and compared, including rates of spasm relief, complications, and recurrence. RESULTS Outcome assessment revealed higher rates of early spasm relief in the interposition group (66.3% vs. 100%, transposition vs. interposition, respectively, p = 0.0004), although spasm relief at 1-year postoperatively was comparable between the two groups (84.9% vs. 95.7%, transposition vs. interposition, respectively, p = 0.2929). No significant differences were observed in complication and recurrence rates. Kaplan-Meier analysis demonstrated no significant differences in the duration of spasm resolution by MVD method (p = 0.4347, log-rank test). CONCLUSION This study shows that both the transposition (Surgicel® and fibrin glue) and interposition (sponge) methods were excellent surgical techniques. The interposition method may achieve earlier spasm resolution compared to the transposition method.
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Affiliation(s)
- Etsuko Owashi
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazufumi Ohmura
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kenji Shoda
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tetsuya Yamada
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kiyomitsu Kano
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Noriyuki Nakayama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan.
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Kanazawa R, Uchida T, Higashida T, Watanabe S, Takahashi Y, Yamazaki K. Use of n-butyl-2-cyanoacrylate for microvascular decompression in a Jehovah's witness patient. Br J Neurosurg 2022:1-4. [PMID: 35400248 DOI: 10.1080/02688697.2022.2061913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/15/2021] [Accepted: 03/29/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE We report the application of n-butyl-2-cyanoacrylate (n-BCA) in microvascular decompression (MVD) surgery for a Jehovah's Witness patient. To our best knowledge, this is the first case wherein n-BCA has been employed as an adhesive to the offending artery. CASE PRESENTATION A 55-year-old female Jehovah's Witness patient was suffering from serious right hemifacial spasm. Although MVD surgery was needed, the patient resisted any curative medical treatment involving the application of whole blood products, including fibrin glue. Thus, we proposed several choices using artificial materials, including n-BCA as an adhesive, and received informed consent from the patient. RESULT MVD was performed on the dolichoectatic right vertebral artery and right posterior inferior cerebellar artery. The abnormal vessel response disappeared during the procedure and transposition using n-BCA of the concerned vessels was successful. The patient experienced a favorable postoperative clinical course and has been free from the spasm for a year. No abnormal findings were detected in the radiological examination during the follow-up period. CONCLUSION Although careful follow-up is mandatory, n-BCA is a possible alternative option in MVD surgery.
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Affiliation(s)
| | - Takanori Uchida
- Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan
| | | | - Saiko Watanabe
- Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan
| | - Yuichi Takahashi
- Department of Neurosurgery, Sassa General Hospital, Tokyo, Japan
| | - Kei Yamazaki
- Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan
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Verbraeken B, Lavrysen E, Aboukais R, Menovsky T. Polyvinyl Alcohol Sponges to Facilitate Cerebral Bypass Surgery: Technical Note. World Neurosurg 2021; 156:53-55. [PMID: 34508907 DOI: 10.1016/j.wneu.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The standard way of isolating bypass vessels from surrounding structures during cerebral bypass surgery has been to use a rubber dam or neurosurgical patty. Here, the use of polyvinyl alcohol (PVA) sponges is described as a possible upgrade from these traditional bypass dams. METHODS PVA sponges were used to isolate bypass arteries from surrounding tissues during microvascular anastomosis in 25 patients undergoing bypass surgery at our institution. RESULTS There were no adverse events related to the use of PVA for microvascular anastomosis. PVA sponges offered some specific advantages when compared with rubber and cottonoid dams. CONCLUSIONS Although preliminary, our experience using PVA sponges during microvascular anastomosis suggests some of their properties can facilitate cerebral bypass surgery.
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Affiliation(s)
- Barbara Verbraeken
- Department of Neurosurgery, Antwerp University Hospital (UZA), Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Eno Lavrysen
- Department of Neurosurgery, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Rabih Aboukais
- Department of Neurosurgery, Lille University Hospital, Lille, France
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital (UZA), Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Mizobuchi Y, Nagahiro S, Kondo A, Arita K, Date I, Fujii Y, Fujimaki T, Hanaya R, Hasegawa M, Hatayama T, Hongo K, Inoue T, Kasuya H, Kobayashi M, Kohmura E, Matsushima T, Masuoka J, Morita A, Munemoto S, Nishizawa S, Okayama Y, Sato K, Shigeno T, Shimano H, Takeshima H, Tanabe H, Yamakami I. Prospective, Multicenter Clinical Study of Microvascular Decompression for Hemifacial Spasm. Neurosurgery 2021; 88:846-854. [PMID: 33469667 DOI: 10.1093/neuros/nyaa549] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Microvascular decompression (MVD) is the most effective procedure for hemifacial spasm (HFS). MVD results from nonspecialized or low-volume institutes are not always reliable. Most studies on MVD for HFS are retrospective and single centered; to the best of our knowledge, no prospective, multicenter studies exist. OBJECTIVE To evaluate short- and long-term outcomes and complications in patients who underwent MVD for HFS in specialized Japanese institutions, in this multicenter, prospective, cohort study. METHODS Included patients had undergone MVD for HFS in study centers between April 2012 and March 2015. Patients' postoperative grade of involuntary movements and complications were recorded postoperatively at 7 d (short-term) and at 1 (mid-term) and 3 (long-term) yr. RESULTS A total of 486 patients (150 men, 336 women; mean age 53.9 yr with 181 patients over 60 yr) were enrolled during the study period. Neuromonitoring was used in 96.3% of the cases. The complete cure rate of symptom relief, mortality rate, and complication rate at short-term follow-up were 70.6%, 0%, and 15%, respectively. The long-term follow-up was completed by 463 patients (95.3%); the complete cure rate of symptom relief and complication rate were 87.1% and 3.0%, respectively. CONCLUSION Our study revealed that under expert guidance and intraoperative neuromonitoring, the long-term curative effect rate of MVD for HFS is high, while complications are uncommon and usually transient. Our results indicate that MVD is an effective and safe treatment for patients with HFS, including elderly patients.
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Affiliation(s)
- Yoshifumi Mizobuchi
- Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan
| | - Shinji Nagahiro
- Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan
| | - Akinori Kondo
- Brain and Spine Surgery Center, Shiroyama Hospital, Osaka, Japan
| | - Kazunori Arita
- Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Isao Date
- Okayama University Graduate School of Medicine, Okayama, Japan
| | | | | | - Ryosuke Hanaya
- Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | | | | | | | - Tooru Inoue
- Graduate School of Medical Sciences, Fukuoka University, Fukuoka, Japan
| | - Hidetoshi Kasuya
- Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | | | - Eiji Kohmura
- Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Jun Masuoka
- Faculty of Medicine, Saga University, Saga, Japan
| | | | | | - Shigeru Nishizawa
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshihiro Okayama
- Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan
| | - Kimitoshi Sato
- Kitasato University School of Medicine, Sagamihara, Japan
| | | | - Hiroshi Shimano
- Brain and Spine Surgery Center, Shiroyama Hospital, Osaka, Japan
| | - Hideo Takeshima
- Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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