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Background: Hemifacial spasm (HFS) is generally caused by the root exit zone of the facial nerve compressed by an overlying arterial loop. HFS can also be caused by various types of tumor, aneurysm, or arteriovenous malformation. We retrospectively analyzed patients to evaluate possible differences in the demographic and clinical features between primary and secondary HFS., Methods: A retrospective study of 3140 cases of HFS treated in our department between January 2009 and June 2016. Among the 3140 total cases, 26 patients had secondary HFS., Results: The 26 tumors of secondary HFS included 11 meningiomas, 8 epidermoid cysts, and 7 vestibular schwannomas. Compared to those with idiopathic HFS, those patients with tumor-induced HFS were significantly younger (P < 0.05). Secondary HFS tended to have responsible vessels, and were observed in 20 (76.92%) of these 26 patients. The long-term effective rate of operation was 84% in the secondary HFS group and was 96.45% in the primary HFS group (P < 0.05); the incidence rate of complication was 12% in the secondary HFS group and was 3.06% in the primary HFS group (P < 0.05)., Conclusions: In cases of secondary HFS, facial nerves of most patients were compressed by blood vessels, so microvascular decompression after tumor resection plays an important role. We should examine the entire nerve root for possible vascular compression., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Extraaxial lymphoma involving the trigeminal nerve, an uncommon condition that presents as a trigeminal schwannoma, resulted in misdiagnosis and a flawed surgical strategy. We report 2 cases: a primary lymphoma of the Meckel cave and a metastasis lymphoma in the prepontine cistern arising from the supraclavicular lymph node., Case Description: The first patient presented with a 3-month history of persistent, sharp facial pain across the area innervated by the V2 nerve. She was misdiagnosed with primary trigeminal neuralgia and underwent microvascular decompression. Intraoperatively, the trigeminal nerve was swollen to a large extent and surrounded by red granuloma-like tissue. The second case was a 75-year-old woman; she had a history of a malignant lymphoma of the supraclavicular lymph node and presented with right facial pain. Magnetic resonance imaging revealed that the cisternal portion of the right trigeminal nerve was swollen. A specimen was taken from the 2 patients, and histopathologic examinations revealed a diffuse large B cell lymphoma., Conclusions: The diagnosis of a malignant lymphoma should be considered for lesions in the trigeminal region. Extracting a specimen for biopsy is the most suitable surgical strategy. Our report indicates that postoperative adjuvant chemotherapy for malignant lymphomas is essential., (Copyright © 2018. Published by Elsevier Inc.)

Background: Microvascular decompression (MVD) has become widely accepted as first-line therapy for hemifacial spasm. However, not all patients are candidates for the procedure, and some surgeons ignore arterioles that represent the actual underlying cause of the condition. The aim of this study was to address the role of involved arterioles in management of MVD in patients with hemifacial spasm., Methods: Data were collected from 765 consecutive patients who underwent MVD from January 2009 to August 2010 in our hospital. Electromyographic abnormal muscle response and Z-L response were used to identify the involved arterioles. All patients were followed for 25-35 months., Results: Compression by the involved arterioles was identified in 20 patients. The most commonly involved arteriole was a branch of the anterior inferior cerebellar artery, followed by the posterior inferior cerebellar artery. During follow-up, effective outcomes were achieved in 93.6% of patients with involved arterioles. There was no MVD-related mortality., Conclusions: The main reason for failed MVD is that the involved offending vessel is not correctly identified. Intraoperative abnormal muscle response and Z-L response are good supplementary measures to identify involved arterioles. In addition, not isolating or coagulating the involved arterioles increases the risk associated with the operation., (Copyright © 2018. Published by Elsevier Inc.)

Objective: Owing to increasing use of Gamma Knife surgery (GKS) for trigeminal neuralgia (TN), physicians are challenged over the problem of choosing an appropriate treatment if GKS fails. The aim of this study was to determine whether microvascular decompression (MVD) is a safe and effective alternative therapy for trigeminal neuralgia in patients with failed GKS., Methods: Between January 1, 2010, and January 1, 2012, data of 32 patients with trigeminal neuralgia who presented with persistent or recurrent pain after GKS and elected to undergo MVD were collected. Clinical characteristics, operative findings, outcomes of MVD, and complications were reviewed., Results: Mean interval time between GKS and MVD was 16 ± 5.64 months (range, 6-27 months). During MVD, the most common offending vessel was the superior cerebellar artery, followed by the anterior inferior cerebellar artery and vertebral artery. Immediately after MVD, 29 patients (90.63%) experienced complete pain relief without medication. At the end of the follow-up period, 25 patients were pain-free without medication., Conclusions: Our data confirm that MVD is an effective and safe alternative therapy after GKS, although the risk of facial numbness seems higher in patients with a history of GKS than in patients without a history of GKS., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Hemifacial spasm (HFS) is a disorder characterized by intermittent, involuntary facial muscle contractions. Microvascular decompression (MVD) is the gold treatment for HFS. The aim of this research was to discuss whether patients undergoing MVD as their initial surgical intervention experience greater spasm control than patients experiencing an MVD performed as a subsequent surgical intervention., Methods: The study included 976 patients with HFS, 452 of whom (group A) underwent MVD as their initial surgical intervention and 524 of whom (group B) underwent subsequent MVD. Relevant clinical data including outcome of MVD, operative findings, complications, and so on were collected immediately after MVD operation and at follow-up., Results: The follow-up period was 7-9 years (mean, 7.96 ± 0.87 years). The mean age at intervention was 53.14 years and 55.43 years in the 2 groups, respectively. The long-term postoperative relief rate of patients in the 2 groups was 98.23% and 87.21%, respectively. There was a significant difference in long-term postoperative relief rate of patients between the 2 groups (P < 0.05)., Conclusions: Patients undergoing MVD for HFS as the primary treatment experience better long-term efficacy than patients first treated with botulinum neurotoxin type A., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Bilateral trigeminal neuralgia is a relatively rare disease. Microvascular decompression (MVD) is a safe and effective treatment for unilateral trigeminal neuralgia; however, its utility in bilateral trigeminal neuralgia is unclear. Here, we report our experience with MVD in 13 cases of primary bilateral trigeminal neuralgia., Methods: We retrospectively analyzed 13 cases of bilateral trigeminal neuralgia that were treated with MVD between January 2013 and January 2015. Surgical outcomes and complications were explored in each case., Results: Postoperatively, 11 patients had excellent outcomes and 2 patients had good outcomes on the operative side. Three patients also reported the amelioration of contralateral symptoms after MVD. Of 10 cases indicating no contralateral improvement, 1 refused to undergo a second MVD procedure on the opposite side and 9 underwent a second MVD procedure and experienced symptom relief. The superior cerebellar artery was the most common offending vessel. There were no severe MVD-related complications., Conclusion: Vascular compression plays a causative role in bilateral and unilateral trigeminal neuralgia. MVD appears to be a safe and effective treatment option in patients who are refractory to pharmacotherapy., (Copyright © 2017. Published by Elsevier Inc.)

Background: Microvascular decompression (MVD) is the most effective treatment for hemifacial spasm (HFS). During MVD surgery, abnormal muscle response (AMR) is widely used. Z-L response (ZLR) is a new monitoring method for HFS. We compared the effectiveness of AMR plus ZLR and simple AMR., Methods: In a retrospective study of 1868 cases of HFS treated using intraoperative monitoring between January 2013 and December 2015, 896 patients underwent simple AMR monitoring and 972 underwent combined intraoperative monitoring of AMR and ZLR., Results: AMR waveforms were observed in 837 (93.42%) patients in the AMR group and in 898 (92.39%) patients in the AMR plus ZLR group (P > 0.05). During MVD, AMR waveforms disappeared in 772 patients in the AMR group and 854 patients in the AMR plus ZLR group (P < 0.05). The efficacy rate of MVD in the AMR plus ZLR group was higher compared with the AMR group when AMR was not detected or disappeared during the operation (P < 0.05). When AMR persisted during the operation, there was no significant difference between the 2 groups in efficacy of the operation (P > 0.05)., Conclusions: Regardless of whether the compression vessels of the facial nerve are simple or complicated, combined intraoperative monitoring of AMR plus ZLR monitoring provides more valuable neurosurgical guidance than simple AMR during MVD for HFS., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Microvascular decompression (MVD) of the trigeminal nerve is the most effective treatment for trigeminal neuralgia (TN). However, many patients respond poorly to initial MVD. For these patients, redo MVD is commonly done. There has been no research regarding the effectiveness of nerve combing (NC) plus MVD in patients with TN and failed prior MVD. We compared the clinical outcome of NC plus MVD and simple redo MVD in patients with TN and failed prior MVD., Methods: We performed a retrospective analysis of 148 patients with recurrent or persistent TN symptoms who underwent surgery between January 2007 and December 2015. Simple MVD was performed in 62 patients, and NC plus MVD was performed in 86 patients., Results: For simple MVD, success rates at 1 day, 7 days, 1 month, 3 months, and 1 year after surgery all were approximately 80%. Success rates of NC plus MVD were significantly (P < 0.05) higher than success rates of simple MVD, by 17.02%, 18.64%, 16.47%, 17.21%, and 14.80% at 1 day, 7 days, 1 month, 3 months, and 1 year. The incidence rates of facial numbness in the simple MVD group were 48.39%, 45.16%, 36.67%, 16.95%, and 1.75% at 1 day, 7 days, 1 month, 3 months, and 1 year; the incidence rates in the NC plus MVD group were 60.47%, 55.81%, 48.24%, 21.69%, and 3.75% (P > 0.05)., Conclusions: In patients with TN who failed prior MVD, NC plus MVD significantly improved the success rate of the operation compared with simple redo MVD. We obtained good short-term and long-term surgical outcomes with NC combined with MVD., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Although microvascular decompression (MVD) surgery is considered the gold standard treatment for hemifacial spasm, there are some MVD-related complications., Methods: We retrospectively reviewed 1548 patients with hemifacial spasm who underwent retromastoid suboccipital craniectomy with MVD from January 2009 to June 2013. All patients were followed for >2 years., Results: Excellent and good results were 92.5% and 4.2%, respectively. Postoperative complications were recorded in 16.09% (n = 249). There was no MVD-related mortality. After MVD surgery, the most frequent complications were occipital sensory disturbance (7.3%), facial nerve palsy (9.7%), and hearing impairment (3.5%). Other complications were as follows: cerebrospinal fluid leakage (n = 24), poor healing wound (n = 14), lower cranial nerve palsy (n = 12), wound infection (n = 4), and hemorrhage (n = 2)., Conclusions: MVD operation is a safe treatment for hemifacial spasm. Facial nerve palsy is the most common MVD-related complication; preservation of the lesser occipital nerve during MVD surgery can decrease the rate of occipital sensory disturbance. Permanent or serious complications are comparatively rare in MVD surgery., (Copyright © 2017. Published by Elsevier Inc.)

Background: Few studies have examined atypical hemifacial spasm (AHFS), and the mechanism of AHFS remains unclear. In this study, we examined the etiology, prognosis, and treatment of AHFS., Methods: We retrospectively analyzed the clinical data for 14 consecutive patients that underwent microvascular decompression (MVD) for AHFS between January 2014 and December 2015. Clinical features, outcomes, and complications were evaluated., Results: The incidence of AHFS is 1.52%. There were no significant differences in sex, age, side and duration between the typical hemifacial spasm and AHFS. During the follow-up period, the effective rate of MVD for patients with AHFS was 92.3%. Three patients developed delayed facial nerve palsy postoperatively, 1 patient experienced occipital sensory disturbance, and 1 patient suffered hearing loss., Conclusions: Most of the cases of AHFS studied here were caused by neurovascular conflict in zone IV of the facial nerve distal to the root entry zone. MVD surgery is the first choice treatment for AHFS., (Copyright © 2017. Published by Elsevier Inc.)

Objective: To examine operative findings and outcome of microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN). This research displayed the long-term outcomes of a large series of 35 cases with GPN treated with MVD., Methods: From January 2004 to June 2006, 35 consecutive patients were diagnosed with GPN. All of them underwent MVD. Demographic data, clinical presentation, operative findings, clinical results, operative complications were reviewed., Results: A total of 33 patients (94.3%) experienced complete pain relief immediately after MVD. Long-term follow-up was available for 30 of these 35 patients, and 28 of these 30 patients continued to be pain-free. There was no long-term operative morbidity in all cases. One patient had a cerebrospinal fluid leak and 1 case presented with delayed facial palsy., Conclusions: Classic GPN is usually caused by pulsatile neurovascular compression of the glossopharyngeal and vagus rootlets. MVD is a safe, effective, and durable operation for GPN., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Microvascular decompression (MVD) of the facial nerve monitored intraoperatively by abnormal muscle response (AMR) activity is a common treatment for hemifacial spasm. AMR frequently persists after MVD, however, for which electromyography (EMG)-guided nerve combing sometimes is recommended. Because no research regarding the success of EMG-guided nerve combing has been published, we compared the effectiveness of nerve combing after MVD with simple MVD in cases including persistent AMR., Methods: A retrospective study of 127 cases of hemifacial spasm treated with persistent AMR after MVD treatment occurring between January 2011 and June 2015 was conducted. Among the 127 total cases, EMG-guided nerve combing was used in 72 patients and simple MVD in 55 patients., Results: For simple MVD, success rates at 1 day, 7 days, 1 month, 3 months, and 1 year after surgery were all approximately 80%; the success rates of MVD with nerve combing were significantly greater (P < 0.05) than those of simple MVD, by 15.83%, 15.4%, 17.22%, 17.65%, and 17.65%, respectively. The incidence rates of facial palsy in simple MVD were 12.73%, 14.55%, 10.91%, 3.64%, and 1.82%, respectively; those in the nerve combing group were 27.78% (P < 0.05 vs. simple MVD), 33.33% (P < 0.05), 25.00% (P = 0.05), 5.55% (P > 0.05), and 2.78% (P > 0.05), respectively., Conclusions: In cases of hemifacial spasm with persistent AMR after MVD, EMG-guided nerve combing significantly improved the success rate of the operation. Although it also significantly increased the incidence of postoperative facial palsy over the short term (up to 1 week), incidences in the long term were not significantly different., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Microvascular decompression (MVD) is the most useful treatment for hemifacial spasm (HFS). During MVD surgery, traditional abnormal muscle response (tAMR) is widely used to monitor success in decompressing the facial nerve. Dual AMR (dAMR) is a new monitoring method used during MVD for HFS. We compared the sensitivities and reliabilities of tAMR and dAMR., Methods: We performed a retrospective study of 1301 cases of HFS treated using MVD between January 2014 and March 2016. Among the 1301 cases, 587 patients underwent tAMR monitoring and 714 underwent dAMR monitoring., Results: Typical abnormal muscle response (AMR) waveforms were observed in 484 patients (82.5%) in the tAMR group and in 688 patients (96.4%) in the dAMR group (P < 0.05). AMR waveforms disappeared in 459 patients in the tAMR group and in 655 patients in the dAMR group during MVD. One day, 7 days, 1 month, and 3 months after MVD surgeries with AMR disappearance, the effective rate of MVD was 95.0%, 94.3%, 94.5%, and 95.0%, respectively, in the tAMR group. The corresponding rates were 97.7%, 96.9%, 97.3%, and 98.0% in the dAMR group (P < 0.05). One day, 7 days, 1 month, and 3 months after MVD surgeries with AMR persistence, the effective rate of MVD was 68.0%, 64.0%, 64.0%, and 64.0%, respectively, in the tAMR group. The corresponding rates were 90.9%, 87.9%, 87.9%, and 90.9% in the dAMR group (P < 0.05)., Conclusions: AMR monitoring provides valuable neurosurgical guidance during MVD for HFS. dAMR monitoring has better sensitivity and reliability than tAMR monitoring., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Microvascular decompression (MVD) has become the best treatment for hemifacial spasm (HFS); however, some patients do not obtain complete relief after the initial MVD. We analyzed a group of patients who underwent a second MVD, to identify the factors that prevented relief after the initial MVD and those that promote the success of the second procedure., Methods: Of a group of 1400 patients with typical primary unilateral HFS treated with MVD between January 2014 and October 2015, we focused on 42 patients with poor postoperative outcomes. All patients underwent abnormal muscle response (AMR) monitoring again the day after surgery. Of those patients, 35 underwent a second MVD surgery within a week. We analyzed their AMRs after each operation., Results: After the first operation, AMR was positive in 40 patients and negative in 2 patients. The latter 2 patients reported spontaneous relief within 1 week. Among the 40 positive patients, 35 and 4 patients underwent a second MVD within a week and 6-11 months, respectively. Thirty-nine patients reported relief after the second MVD; 1 patient remained unchanged at follow-up (<12 months)., Conclusions: When initial MVD does not provide relief, a repeat MVD should be performed as soon as possible. In 2/42 cases, relief was delayed enough that AMR had a false-negative result. Combinative monitoring of AMR and Z-L responses was important in identifying the real cause of HFS., (Copyright © 2016 Elsevier Inc. All rights reserved.)