Treatment choice consists of two methods. For patients against surgery, Botox injection will be the first choice. However, the effect diminishes within 3 months and requires repeat injections. On the other hand, microvascular decompression can lead to complete cure. 3D imaging of the nerve and vessels is very helpful to understand the specific patient conditions which contributes to safer and effective surgery.
Injection with a tiny needle can reduce the pain during the procedure. The amount of Botox injected is determined by the severity of facial spasm in each patient. The effect continues for about 3 months. Too many repeated injections are not recommended as mixed spasm and palsy status may make MVD result complicated.
MR and CT imaging with 3D reconstruction are used to diagnose the cause of hemifacial spasm, which is usually an artery compressing the facial nerve, but may be due to other causes of compression.
Microvascular decompression for hemifacial spasm is performed through a key hole with small skin incision. Transposition techniques (sling or bridge technique) is used instead of the interposition technique to avoid failure and recurrence.
This beautiful lady came from Hawaii, USA.
She suffered from hemifacial spasm on the right side for 9 years and was forced to quit her career as a school teacher due to HFS.
The 3D imaging revealed the anterior inferior cerebellar artery compressing the root entry zone of the facial nerve. This 3D imaging contributed to her successful MVD.
This patient came from Hong Kong. The responsible artery was not identified in other hospitals. MRI taken at Koto Memorial Hospital identified the culprit vessel with 3D imaging. The artery was transposed using bridge technique through a keyhole craniotomy. Her HFS completely subsided immediately after MVD. (This presentation is varid for the end of 2021)
He is a physician in Nevada, USA, and suffered from hemifacial spasm on the left side for 5 years.
His first MVD was performed in Pittsburgh, Pennsylvania, which failed to improve the HFS. His HFS worsened after the first surgery.
3D imaging created at Koto Memorial Hospital disclosed a massive Teflon (green object in 3D video) inserted between the facial nerve and the responsible artery. The surgery was performed to remove the excess Teflon (white material in OP video) to obtain sufficient decompression of the nerve. His HFS disappeared immediately after the surgery.
Pre - operative 3D imaging
The Teflon felt was removed
This patient had prior MVD with interposition technique.
HFS persisted due to too much Teflon inserted between the nerve and the compressing artery (microvascular recompression).
After removal of the excess of Teflon felt and appropriate transposition of the artery with sling technique, her symptoms were cured immediately after surgery.
Too much Teflon is compressing the facial nerve.
Teflon was removed and the compressing artery is exposed.
The artery is now transposed with the sling technique. The REZ of facial nerve is free from any kind of compression.
He underwent his 1st MVD in a local hospital in Singapore. The site of craniotomy made the procedure difficult, resulting in no improvement of HFS.
Our 3D imaging study revealed 4 arteries, both side of the vertebral arteries, the posterior inferior cerebellar artery, and the anterior inferior cerebellar artery, were involved in neurovascular compression. The vessels were securely lifted with a Teflon bridge away from the REZ.
3D imaging showed multiple vascular compression.
The arteries were elevated from the REZ.
The post OP CT showed that the vessels were securely elevated with a Teflon bridge (green).
He is so happy with spasm free after 2nd MVD.
Hemifacial spasm on the left side for the last 12 years.
Surgery at other hospitals failed to relieve her facial spasm.
We precisely evaluated using 3D imaging and performed microvascular decompression, resulting in successful relief of her symptom.
These large vessels require meticulous decompression technique.
Paroxysmal diplopia when stressed or speaking with others, lasting ~10-20 sec. Neurological finding revealed paroxysmal downward deviation of the left eye when the spell occurs. 3D imaging showed the left oculomotor nerve pinched by two different arteries. Microvascular decompression transposed these arteries, leading to resolution of her symptom.
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