Best MVD Surgery Video with Steps: MVD (microvascular decompression) Surgery of facial nerve (hemifacial spasm treatment)



Check out this Brain surgery video: This is an excellent video presentation of suboccipital craniectomy with careful exposure of seventh cranial nerve and microvascular decompression of the nerve (MVD) with successful treatment of hemifacial spasm. Case presentation by Dr. Farhad Limonadi MD, director of neurosurgery at Eisenhower hospital. Edited by Camus Yu. This surgery is considered to be the best treatment for hemifacial spasms.

What is Hemifacial Spasm?

Hemifacial spasm (HFS) is characterized by unilateral, intermittent contractions of the muscles liable for face expression. This spasm typically begins within the orbicularis oculi and spreads to other muscles of expression over the course of several years. there's now considerable evidence that primary HFS is, in most cases associated with vascular compression of the seventh cranial nerve at its Root Exit Zone (REZ) from the brainstem. Microvascular decompression (MVD) constitutes a curative treatment and is currently the sole etiologic-based therapy with the best-associated outcome

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Surgical technique (Operative Procedure) MVD (microvascular decompression) Surgery of facial nerve


Position:

  • Lateral position on 3 pin with padding of pressure points

  • Vertex placed parallel to the floor

Incision

  • Small RMSOC

  • Iniomeatal line – transverse sinus

  • Digastric groove posterior to mastoid eminence – sigmoid sinus

  • Mastoid emissary vein- overlies sigmoid-transverse sinus junction

Retromastoid craniectomy

  • Bevel bone laterally

  • Sufficient anterior exposure reduces amount of cerebellar retraction


C-shaped dural opening


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Exposure of CPA

  • Retraction of cerebellum supero-medially to drain CSF 

  • Preserve petrosal vein


Visualization of Facial nerve- VIII Nerve Complex


Decompression

  • 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. 


Intraoperative Monitoring

  • 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. 

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