Best MVD Surgery Video with Steps: MVD (microvascular decompression) Surgery of facial nerve (hemifacial spasm treatment)
What is Hemifacial Spasm?
Surgical technique (Operative Procedure) MVD (microvascular decompression) Surgery of facial nerve
Lateral position on 3 pin with padding of pressure points
Vertex placed parallel to the floor
Iniomeatal line – transverse sinus
Digastric groove posterior to mastoid eminence – sigmoid sinus
Mastoid emissary vein- overlies sigmoid-transverse sinus junction
Bevel bone laterally
Sufficient anterior exposure reduces amount of cerebellar retraction
C-shaped dural opening
Exposure of CPA
Retraction of cerebellum supero-medially to drain CSF
Preserve petrosal vein
Visualization of Facial nerve- VIII Nerve Complex
Dissect arachnoid over the nerve; free the nerve from tethering points
Shredded teflon felt placed in between in proximal to distal fashion.
Teflon is used: Well tolerated, not reabsorbed, low complication rate
Other materials used previously- cotton, ivalon sponge, Dacron sponge, muscle, gelfoam, Gore-tex pad, fenestrated clips)
Arteries to be never sacrificed.
- Helpful to prevent injury to the brainstem and cranial nerves
- Facial nerve monitoring
- Brainstem auditory evoked potentials are very sensitive to stretch-induced injury to the eighth cranial nerve
- A delay in comparison with baseline readings of more than 20% or a shift in interpeak latency of more than 1.5 to 2 milliseconds requires loosening of cerebellar retraction until the signals normalize.