Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience

Publication date: Available online 9 May 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Giampietro Ricci, Arianna Di Stadio, Luca D'Ascanio, Ruggero La Penna, Franco Trabalzini, Antonio Della Volpe, Jacques Magnan
IntroductionThe use of surgical decompression of facial hemispasm due to the loop in the internal auditory canal is not always accepted due to the risk related to the surgical procedure. Currently a new surgical technique allows surgeons to work in safer conditions.ObjectiveTo report the results with endoscope-assisted retrosigmoid approach for facial nerve microvascular decompression in hemifacial spasm due to neurovascular conflict. The surgical technique is described.MethodsWe made a prospective study in a tertiary referral center observing 12 (5 male, 7 female) patients, mean age 57.5 (range 49–71) years affected by hemifacial spasm, that were submitted to an endoscope assisted retrosigmoid approach for microvascular decompression. We evaluated intra-operative findings, postoperative HFS resolution and complication rates.ResultsHemifacial spasm resolution was noticed in 9/12 (75%) cases within 24h after surgery and in 12/12 (100%) subjects within 45 days. A significant (p<0.001) correlation between preoperative historical duration of hemifacial spasm and postoperative recovery timing was recorded. Only 1 patient had a complication (meningitis), which resolved after intravenous antibiotics with no sequelae. No case of cerebrospinal fluid leak, facial palsy or hearing impairment was recorded. Hemifacial spasm recurrence was noticed in the only subject where the neurovascular conflict was due to a vein within the internal auditory canal.ConclusionsThe endoscope assisted retrosigmoid approach technique offers an optimal visualization of the neurovascular conflict thorough a minimally invasive approach, thus allowing an accurate decompression of the facial nerve with low complication rates. Due to the less invasive nature, the procedure should be considered in functional surgery of the cerebellar pontine angle as hemifacial spasm treatment, specially when the procedure is performed by an otolaryngologist.



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