Vertebral artery pexy for microvascular decompression of the facial nerve in the treatment of hemifacial XXXX .

@entity1 @entity64 @entity2850 @entity392 @entity2473 @entity5487 @entity393 @entity531 @entity912
OBJECT: Hemifacial @entity2473 (HFS) is caused by arterial or venous @entity2850 VII at its root exit zone. Traditionally, microvascular decompression of the facial nerve has been an effective treatment for posterior inferior and anterior @entity5487 as well as venous compression. The traditional technique involves Teflon felt or another construct to cushion the offending vessel from the facial nerve, or cautery and division of the offending vein. However, using this technique for severe vertebral artery (VA) compression can be ineffective and fraught with complications. The authors report the use of a new technique of VA pexy to the petrous or clival dura mater in @entity1 with HFS attributed to a severely ectatic and tortuous VA, and detail the results in a series of @entity1 . METHODS: Six @entity1 with HFS due to VA compression underwent a retrosigmoid craniotomy, combined with a far-lateral approach in some @entity1 . On identification of the site of VA compression, the vessel was mobilized adequately for the decompression. Great care was taken to avoid kinking the perforating vessels arising from the VA. Two 8-0 nylon sutures were passed through to the wall of the VA and then through the clival or petrous dura, and then tied to alleviate compression on cranial nerve VII. RESULTS: @entity1 were followed for at least 1 year postoperatively (mean 2.7 years, range 1-4 years). All 6 @entity1 had complete resolution of their HFS. Facial function was tested postoperatively, and was stable when compared with the preoperative baseline. Two of the 3 @entity1 with preoperative @entity392 had resolution of this symptom after the procedure. Postoperative imaging demonstrated VA decompression of the facial nerve and no evidence of @entity64 in all @entity1 . One @entity1 suffered from @entity393 , another developed a postoperative transient unilateral vocal @entity912 , and a third @entity1 developed a pseudomeningocele that resolved with the placement of a lumbar drain. CONCLUSIONS: Hemifacial @entity2473 and other @entity531 are effectively treated by repositioning the compressing artery. Careful study of the preoperative MR images may identify a select group of @entity1 with HFS due to an ectatic VA. Rather than traditional decompression with only pledget placement, these @entity1 may benefit from a VA pexy to provide an effective, safe, and durable resolution of their symptoms while minimizing surgical complications.
