J Korean Neurosurg Soc.  2016 Sep;59(5):505-511. 10.3340/jkns.2016.59.5.505.

Bioglue-Coated Teflon Sling Technique in Microvascular Decompression for Hemifacial Spasm Involving the Vertebral Artery

Affiliations
  • 1Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea. yhahn00@naver.com
  • 2Department of Neurosurgery, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Korea.
  • 3Neuroscience Graduate Program, Department of Biomedical Sciences, Graduate School of Ajou University, Suwon, Korea.

Abstract


OBJECTIVE
Microvascular decompression (MVD) for hemifacial spasm (HFS) involving the vertebral artery (VA) can be technically challenging. We investigated the therapeutic effects of a bioglue-coated Teflon sling technique on the VA during MVD in 42 cases.
METHODS
A bioglue-coated Teflon sling was crafted by the surgeon and applied to patients in whom neurovascular compression was caused by the VA. The radiologic data, intra-operative findings with detailed introduction of the procedure, and the clinical outcomes of each patient were reviewed and analyzed.
RESULTS
The 42 patients included in the analysis consisted of 22 females and 20 males, with an average follow-up duration of 76 months (range 24-132 months). Intraoperative investigation revealed that an artery other than the VA was responsible for the neurovascular compression in all cases : posterior inferior cerebellar artery (PICA) in 23 patients (54.7%) and anterior inferior cerebellar artery (AICA) in 11 patients (26.2%). All patients became symptom-free after MVD. Neither recurrence nor postoperative neurological deficit was noted during the 2-year follow-up, except in one patient who developed permanent deafness. Cerebrospinal fluid (CSF) leak occurred in three patients, and one required dural repair.
CONCLUSION
Transposition of the VA using a bioglue-coated Teflon sling is a safe and effective surgical technique for HFS involving the VA. A future prospective study to compare clinical outcomes between groups with and without use of this novel technique is required.

Keyword

Hemifacial spasm; Vertebral artery; Microvascular decompression; Sling; Teflon; Bioglue

MeSH Terms

Arteries
Cerebrospinal Fluid
Deafness
Female
Follow-Up Studies
Hemifacial Spasm*
Humans
Male
Microvascular Decompression Surgery*
Polytetrafluoroethylene*
Prospective Studies
Recurrence
Therapeutic Uses
Vertebral Artery*
Polytetrafluoroethylene
Therapeutic Uses

Figure

  • Fig. 1 Preparation of hand-made bioglue-coated Teflon sling. Several Teflon threads were prepared (A) and these were manually twisted with application of bioglue to make an elongated bioglue-coated Teflon strand with a smooth-surface that was lint-free and had good tensile strength (B). Schematic illustration of the stranded Teflon (C). Scale=1 mm.

  • Fig. 2 Intraoperative microscopic view during MVD. A : The loop of the VA and the PICA are seen compressing the root exit zone (REZ) of the facial nerve. B : The VA was adequately lifted using the sling, which was fixed to the 5-0 black silk sutures on the petrosal dura. C : PICA was fully identified on the REZ only after transposition of the VA. D : An indentation was seen on the REZ after the decompression (arrowhead). E : Schematic illustration showing compression of the facial nerve by the VA and the PICA. F : After transposition of the VA using a bioglue-coated Teflon sling, the PICA compressing on the REZ of the facial nerve is fully identified. G : The PICA was fixed to the transposed VA with applications of several pieces of TachoSil (Takeda GmbH, Linz) and Tisseel bioglue (Baxter). MVD : microvascular decompression, VA : vertebral artery, PICA : posterior inferior cerebellar artery.

  • Fig. 3 Pre- and postoperative magnetic resonance imaging (MRI). A : Preoperative MRI : the loop of the VA (arrows) was suspected to compress the REZ of the facial nerve. B : Postoperative MRI : the loop of the VA was shifted in the lateral direction. REZ : root exit zone.


Cited by  1 articles

Microvascular Decompression for Glossopharyngeal Neuralgia: Clinical Analyses of 30 Cases
Mi Kyung Kim, Jae Sung Park, Young Hwan Ahn
J Korean Neurosurg Soc. 2017;60(6):738-748.    doi: 10.3340/jkns.2017.0506.010.


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