Department of Neurosurgery, Subarukai Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, 527-0134, Shiga, Japan.
Department of Neurosurgery, Indonesia National Brain Center Hospital, East Jakarta, Special Capital Region of Jakarta, Indonesia.
Acta Neurochir (Wien). 2022 Dec;164(12):3235-3246. doi: 10.1007/s00701-022-05397-2. Epub 2022 Oct 27.
A thorough observation of the root exit zone (REZ) and secure transposition of the offending arteries is crucial for a successful microvascular decompression (MVD) for hemifacial spasm (HFS). Decompression procedures are not always feasible in a narrow operative field through a retrosigmoid approach. In such instances, extending the craniectomy laterally is useful in accomplishing the procedure safely. This study aims to introduce the benefits of a skull base approach in MVD for HFS.
The skull base approach was performed in twenty-eight patients among 335 consecutive MVDs for HFS. The site of the neurovascular compression (NVC), the size of the flocculus, and the location of the sigmoid sinus are measured factors in the imaging studies. The indication for a skull base approach is evaluated and verified retrospectively in comparison with the conventional retrosigmoid approach. Operative outcomes and long-term results were analyzed retrospectively.
The extended retrosigmoid approach was used for 27 patients and the retrolabyrinthine presigmoid approach was used in one patient. The measurement value including the site of NVC, the size of the flocculus, and the location of the sigmoid sinus represents well the indication of the skull base approach, which is significantly different from the conventional retrosigmoid approach. The skull base approach is useful for patients with medially located NVC, a large flocculus, or repeat MVD cases. The long-term result demonstrated favorable outcomes in patients with the skull base approach applied.
Preoperative evaluation for lateral expansion of the craniectomy contributes to a safe and secure MVD.
彻底观察神经根出口区（REZ）并安全移位致病动脉对于面肌痉挛（HFS）的微血管减压术（MVD）的成功至关重要。通过乙状窦后入路，在狭窄的手术野中，减压术并不总是可行的。在这种情况下，横向扩展颅切除术有助于安全地完成该手术。本研究旨在介绍颅底入路在 HFS 的 MVD 中的益处。
在 335 例连续 HFS 的 MVD 中，有 28 例患者采用颅底入路。神经血管压迫（NVC）的部位、绒球的大小以及乙状窦的位置是影像学研究中的测量因素。通过回顾性评估，评估并验证颅底入路的适应症，并与传统乙状窦后入路进行比较。回顾性分析手术结果和长期结果。
27 例患者采用扩展乙状窦后入路，1 例患者采用迷路后经乙状窦前入路。包括 NVC 部位、绒球大小和乙状窦位置在内的测量值很好地反映了颅底入路的适应症，与传统乙状窦后入路有显著差异。颅底入路对于 NVC 位于内侧、绒球较大或需要重复 MVD 的患者很有用。长期结果显示，采用颅底入路的患者结果良好。
术前评估颅切除术的横向扩展有助于安全、可靠地进行 MVD。
