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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Microvascular decompression for pediatric-onset hemifacial spasm: case series and literature review
Anpei Jia1, Ning Ning Dou2, Jun Zhong3
1Shidong Hospital, University of Shanghai for Science and Technology, Shanghai, 200092, China.
Objectives:
Pediatric hemifacial spasm has been rarely reported in the literature, which contains only 44 cases. Although microvascular decompression (MVD) has been widely regarded as effective therapy for hemifacial spasm, the etiology and surgical treatment of pediatric patients are seldom reported. We report our experience with MVD for pediatric hemifacial spasm patients and review the literature with emphasis on the difference from adults.
Methods:
This retrospective report included 4 pediatric HFS patients, who underwent MVD in our department between January 2014 and May 2021 and then reviewed all the pediatric hemifacial spasm literature on "pubmed" with emphasis on the clinical data.
Results:
Our series included 1 boy and 3 girls with an average age of 15.6 ± 3.2 years old; their onset ages were from 7 to 16 years old (11.6 ± 4.3). Three patients achieved immediate excellent outcomes and 1 achieved poor immediately and became good 6 months later. During the operation, all the 4 patients were found compressed by anterior inferior cerebellar artery (AICA). The incidence of pediatric atypical hemifacial spasm patients is 12.5% among the 48 reported cases, which is much higher than adults. Among all the reported 48 cases including ours, the singular artery neurovascular conflictions account for 27/48(56%), the singular vein and combined artery/vein conflictions in 12/48(25%) and the cisternal conflictions in 5/48(10.4%) patients.
Conclusions:
The etiology of pediatric hemifacial spasm is still neurovascular conflict, of which combined artery/vein and singular venous compression patterns have a higher proportion, which might explain higher incidence of pediatric atypical hemifacial spasm and less favorable postoperative outcome. Sufficient arachnoid release, full exploration and decompression along the facial nerve are necessary, which would help to increase the excellent postoperative cure rate among pediatric patients.
Insights
Microvascular decompression (MVD) is effective for pediatric hemifacial spasm (HFS). Combined artery/vein compression is more common in children, potentially impacting outcomes. Careful surgical decompression improves cure rates.
Area of Science:
- Neurosurgery
- Pediatric Neurology
Background:
- Pediatric hemifacial spasm (HFS) is rare, with limited data on its etiology and treatment.
- Microvascular decompression (MVD) is a standard therapy for HFS, but its application in children is less explored.
Purpose of the Study:
- To report on the experience with MVD in pediatric HFS patients.
- To review existing literature on pediatric HFS, focusing on differences from adult cases.
Main Methods:
- Retrospective analysis of 4 pediatric HFS patients who underwent MVD.
- Literature review of pediatric HFS cases from PubMed, emphasizing clinical data.
Main Results:
- The study included 4 pediatric patients (1 boy, 3 girls) with HFS.
- All patients experienced neurovascular compression, primarily by the anterior inferior cerebellar artery (AICA).
- Pediatric atypical HFS incidence (12.5%) is higher than in adults, with a notable proportion of combined artery/vein or singular venous compression.
Conclusions:
- Neurovascular conflict remains the primary cause of pediatric HFS.
- Higher proportions of combined artery/vein and singular venous compression may contribute to increased atypical HFS and less favorable outcomes in children.
- Thorough arachnoid release and facial nerve decompression are crucial for improving surgical outcomes in pediatric HFS.
