Department of Neurosurgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA.
Northwestern University, Feinberg School of Medicine, Neurological Surgery, Chicago, IL, USA.
Oper Neurosurg (Hagerstown). 2021 Nov 15;21(6):540-548. doi: 10.1093/ons/opab348.
Hemifacial spasm (HFS) is a socially limiting condition leading to decreased quality of life that can be treated with microvascular decompression (MVD). Endoscopy has been described as an adjunct to traditional microscopy for MVD, although the best visualization technique is debated.
To review the current literature on use of endoscopy in MVD for HFS and to describe the simultaneous microscopic and endoscopic visualization technique along with a video illustration.
Patients who underwent MVD for HFS were retrospectively reviewed from January 2011 to December 2019. The first set of patients in the series were done using traditional endoscopic assisted visualization, followed by a change in technique in the subsequent patients using the simultaneous endoscopic technique. The surgical technique is described as well as illustrated with a video.
In total, 21 patients underwent 24 MVDs to treat HFS. The simultaneous endoscopic/microscopic technique was used in 48% of cases for visualization. All but one patient had resolution of their symptoms immediately after the procedure. In total, 7 patients had recurrence of HFS, with 4 (17%) resolving spontaneously and 3 (13%) ultimately undergoing redo MVD. Postoperatively 7 patients (29%) had transient complications that all resolved completely. There was no significant difference between the traditional alternating microscopic and endoscopic technique with the simultaneous endoscopic microscopic technique.
Endoscopic assistance during MVD for HFS is beneficial and may be streamlined by using the simultaneous microscope and endoscope visualization technique.
面肌痉挛（HFS）是一种会降低生活质量的社交受限疾病，可以采用微血管减压术（MVD）进行治疗。尽管最佳可视化技术存在争议，但内镜已被描述为 MVD 的传统显微镜的辅助手段。
回顾 MVD 治疗 HFS 中使用内镜的当前文献，并描述同时进行显微镜和内镜可视化的技术，并附有视频说明。
回顾性分析 2011 年 1 月至 2019 年 12 月期间接受 MVD 治疗 HFS 的患者。该系列中的第一组患者采用传统内镜辅助可视化方法进行治疗，随后在后续患者中采用同时进行内镜技术进行治疗。手术技术也有描述，并附有视频说明。
共有 21 例患者接受了 24 例 MVD 手术来治疗 HFS。有 48%的病例采用同时进行内镜/显微镜技术进行可视化。除 1 例患者外，所有患者术后即刻症状均得到缓解。共有 7 例患者出现 HFS 复发，其中 4 例（17%）自发缓解，3 例（13%）最终接受了再次 MVD。术后有 7 例（29%）患者出现短暂性并发症，均完全缓解。传统的交替显微镜和内镜技术与同时进行的显微镜和内镜可视化技术之间没有显著差异。
在 MVD 治疗 HFS 期间，内镜辅助是有益的，并且通过使用同时进行显微镜和内镜可视化技术可以简化流程。
