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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
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Proper Head Rotation when Performing Microvascular Decompression for Hemifacial Spasm: An Orthometric Consideration

Hak-Cheol Ko1, Seung Hwan Lee1, Hee Sup Shin1

  • 1Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Seoul, Republic of Korea.

Journal of Neurological Surgery. Part A, Central European Neurosurgery
|February 16, 2022
PubMed
Summary
This summary is machine-generated.

Microvascular decompression for hemifacial spasm is optimized by precise head rotation based on preoperative MRI measurements. This ensures adequate surgical corridors and successful outcomes by avoiding cerebellar injury.

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Area of Science:

  • Neurosurgery
  • Anatomy
  • Medical Imaging

Background:

  • Standard microvascular decompression (MVD) for hemifacial spasm (HFS) utilizes a lateral decubitus position with 10-degree head rotation away from the affected side.
  • This study investigated posterior fossa angles to determine optimal surgical positioning for MVD in HFS patients.

Purpose of the Study:

  • To identify the optimal patient head rotation for microvascular decompression (MVD) surgery in treating hemifacial spasm (HFS).
  • To correlate anatomical measurements with surgical corridors to enhance operative positioning.

Main Methods:

  • Preoperative magnetic resonance imaging (MRI) was used to assess key parameters: petrous angle (PA), sigmoid angle (SA), sigmoid diameter (SD), and root exit zone-sigmoid sinus edge angle (REZ-SEA).

Main Results:

  • Mean measurements included PA (59.7°), SA (16.8°), SD (13.4 mm), and REZ-SEA (59.6°).
  • The average midpoint of the usable operative microscope angle range was 38.2°.

Conclusions:

  • A 10-degree head rotation away from the affected side is generally suitable for MVD surgery, providing a mean microscope angle of 48°.
  • Individual patient anatomy, particularly concerning SA, REZ-SEA, and SD, necessitates precise, MRI-based head rotation adjustments for successful MVD surgery.