顔面けいれんや三叉神経痛の手術は比較的単純な手技ですが、10-20%で困難な手術があります。再手術は難易度が高くなるので、初回手術の成功が重要です。
The healing process following the initial surgery can lead to scarring, which causes the cerebellum to adhere to surrounding structures, obscuring clear access to the compression site.
The presence of previously inserted Teflon pads, intended to prevent nerve compression, complicates the anatomy further. These pads, along with any displacement of anatomical structures, make navigation and identification of critical areas more challenging.
Cranial nerves, potentially compromised or damaged during the initial surgery, present a rising risk. Their identification and preservation become significantly more complex amidst the altered landscape.
Distinguishing the cranial nerve within the mass of Teflon and scar tissue requires exceptional skill and precision, as the nerve is crucial for facial movement or sensation of the face.
The cumulative effect of these challenges means that repeat MVD is akin to navigating the complexities of advanced skull base surgery. It carries an increased risk of cranial nerve injuries and demands a nuanced understanding of the altered surgical field. Moreover, the presence of Teflon felt from the previous surgery complicates the path to decompressing facial nerve, underscoring the surgery's complexity and the delicate balance required to restore function.
While MVD is often perceived as a simple procedure, approximately 10-20% of patients present with complex anatomical conditions that necessitate advanced surgical techniques. For those whose initial surgeries have not yielded success, the choice between undergoing a more daunting repeat surgery or living with HFS/TGN for the rest of their lives poses a significant dilemma.
Our center proudly serves patients from across the globe, including those approaching us for their initial treatment and individuals in search of hope following unsuccessful surgeries elsewhere. Our commitment is deeply rooted in the precision of repeat MVD surgeries. Each procedure is performed with the utmost precision, expertise, and an unwavering dedication to our patients' well-being. We are privileged to be part of our patients' journeys towards regaining their smiles and the normalcy of their lives, offering a beacon of hope for conditions once deemed irreversible. Our success is not merely quantified by the number of procedures we execute but by the positive impact we have on the lives of those we serve, guiding each patient along the intricate path towards healing and recovery.
Potential reasons for failure and recurrence in microvascular decompression for hemifacial spasm. Acta Neurochir (Wien). 2023 Dec;165(12):3845-3852. Inoue T, Goto Y, Inoue Y, Adidharma P, Prasetya M, Fukushima T.
Redo surgery for trigeminal neuralgia: reasons for re-exploration and long-term outcomes. Acta Neurochir (Wien). 2021 Sep;163(9):2407-2416. Inoue T, Shitara S, Goto Y, Prasetya M, Radcliffe L, Fukushima T.
A determined woman from Spain, after three unsuccessful MVD surgeries, sought hope at Koto Memorial Hospital. Previous attempts had left the true compressing artery unaddressed, obscured by Teflon mass and scar tissue. Facing her fourth surgery, her surgeon encountered unprecedented challenges. This operation, marked by extreme intricacy, finally revealed and corrected the elusive artery, highlighting the importance of the initial intervention.
After 3 Failed MVDs
After 4th MVD at KMH
Article : https://link.springer.com/article/10.1007/s00701-021-05006-8
Video : https://ars.els-cdn.com/content/image/1-s2.0-S2590139723000066-mmc1.mp4
She underwent two unsuccessful microvascular decompression surgeries in Dubai, which resulted in loss of hearing on the left side and temporary issues with hoarseness and swallowing difficulties. A large Teflon pad, used in the surgeries, was placed on the nerve root, leading to persistent stimulation of the nerve and worsening her facial spasms. The prolonged contact with the Teflon pad placed during the initial surgery has caused persistent nerve stimulation, resulting in a complex and challenging treatment course.
After 2 Unsuccessful MVDs
Inten & Continuous spasm
After 3rd MVD at KMH
Post OP 1 month (mirror image)
In a previous surgery in Japan, Teflon placement near the nerve root did not relieve her symptoms due to an incorrect craniotomy limiting access to the compressed nerve area. In a redo surgery at our hospital, the craniotomy was enlarged and adjusted, allowing for clear visualization and successful repositioning of the compressing artery, leading to a successful outcome.
tel.0749-45-3177
京都での診察をご希望の方は
蘇生会総合病院 tel.075-621-3101
関東での手術を希望の方は名戸ヶ谷病院へ
脳神経外科 井上靖章医師（nadogaya.neurosurgery@gmail.com）
※要予約※Reservation required.
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| 湖東記念病院 Koto Memorial HospitalWebSite |
日本、滋賀 Shiga, Japan |
| 蘇生会総合病院 Soseikai General HospitalWebSite |
日本、京都 Kyoto, Japan |
| 名戸ヶ谷病院 Nadogaya hospitalWebSite |
日本、千葉 Chiba, Japan |
| 志太記念脳神経外科 Shida Memorial Neurosurgery ClinicWebSite |
日本、静岡 Shizuoka, Japan |
| Andalusia HospitalWebSite | Alexandria, Egypt |
| National Brain Center HospitalWebSite | Jakarta, Indonesia |
湖東記念病院脳神経外科主任部長
日本脳神経外科学会専門医
