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Vascular Compression Causing Hemifacial Spasm: Variation

January 16, 2015


A variety of vascular compression configurations are found during MVD for Hemifacial spasm. This video reviews one of the special configurations where a special caution has to be paid to the vascular compression due to presence of the labyrinthine artery. This is a young patient who was suffering from left sided hemifacial spasm, you can see the left eighth cranial nerve seventh cranial nerve just in front of the first nerve. And you can see this artery that is following its route to the internal auditory meatus. This artery most likely is labyrinthine artery and should not be manipulated since any mild or minor injury to this vessel could lead to hearing loss. You can see this is a video from years before where we used to use fixer tractors, and you can see the amount of compression needed to expose the root exit zone of the facial nerve actually without using retractors you would only use suction apparatus as a dynamic retractor, and we'll be able to expose just a point of pathology without necessarily placing the entire segment of the cerebellum at risk with rigid retractor. So the labyrinthine artery which again, follows the nerve into the auditory meatus was first considered to be potentially an offending vessel. However, mobilization of this artery and looking behind it will reveal the actual offending vessel. Here is mobilization of the labyrinthine artery superiorly between the seven and eight cranial nerve where it's usually located. And now the real vascular loop is evident. Therefore, the surgeon has to always watch for the labyrinthine artery which is again, typically located between the seventh and eighth cranial nerve and enters the internal auditory meatus and focuses her attention on the vessel at the root exit zone of the facial nerve. You can see the discoloration at the root exit zone of the facial nerve. Here's the exit zone of the nerve piece of shredded Teflon, again is mobilized and placed between the vascular loop and the facial nerve. Again, the labyrinthine artery should be carefully protected and if it's in any spasm the should be used to protect the artery. And here's the final product demonstrating the technique of decompression. Thank you.

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