Classic Vascular Compression During MVD for Hemifacial Spasm

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- This is another video describing technique for MVD, for hemifacial facial spasm. This is a one of my young patients who presented with long standing history of left sided hemifacial spasm. Her T2 sequence, axial MRI on the left side, revealed a vasculature of potentially causing conflict at the root exits on of the facial nerve. She subsequently underwent a left sided, retro-mastoid, craniotomy. You can see the incision and the position in this case, we have come to use actually a smaller incision in the recent years where this summit of incision actually does not need to expose the transverse sigmoid junction. You can see some of the landmarks that we have described in the previous videos left sided, retro mastoid craniotomy was exposed. The sigmoid sinus can be seen here. Again, this is slightly bigger craniotomy then needed for this procedure. The initial retraction should not be parallel to the seventh, eighth cranial nerve. In this circumstances, small meningeal artery or ethmoid band was present, which was released at the area of the seven and eighth cranial nerves. And then we divert attention to the lower cranial nerves, as you can see here. Here's the ninth cranial nerve that was followed to the root exit zone of the seventh cranial nerve. A vascular loop is evident here. You can see that dynamic suction allows me to retract the vascular structures just at the area that I need to, to find the pathology. Some of the perforators, the small ones were suffering from some spasm and therefore a soaked gel foam was used to relieve their spasm. Here's the vascular loop. Here's the root exit zone of the facial nerve that is evident as you can see the discoloration in this area, you can see actually the root exit zone is much more inferior than one thinks compared to the seventh. I'm sorry, compared to the eighth cranial nerve. The pieces of shredded Teflon was placed between the vascular loop and the root exit zone of the nerve as was the brainstem. I made sure the perforators are carefully protected and are not entangled within the Teflon patch. And you can see the healthy status of the cerebellum at the end of the procedure. You can see the seventh and eighth cranial nerve. You can see that all the exposures needed really below these nerves, additional exposure above these nerves is not necessary. And that's why we have confined our smaller craniotomies to this location.

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