33. Application of keyhole retrosigmoid approach for cerebellopontine angle lesions
Main Article Content
Abstract
This prospective study was conducted to assess the initial application of a minimally invasive surgical approach retrosigmoid in the treatment of pathologies in the cerebellopontine angle (CPA). The subjects were 36 patients who underwent surgery via the minimally invasive sub-sigma corridor for the treatment of pathologies of the cerebellopontine angle (trigeminal neuralgia, hemifacial spasm) at the Department of Neurosurgery - Spine, Hanoi Medical University Hospital from January 2023 to September 2023. The results showed that trigeminal neuralgia was the most common pathology, corresponding to 66.67%, followed by hemifacial spasm at 33.33%. The average length of the skin incision was 3.5 ± 1.6cm, and the average skull bone flap area was 3.7 ± 0.5cm2. One month postoperatively, complete relief from trigeminal neuralgia was achieved in 91% of cases, while 9% experienced partial relief or reduction of symptoms. The quality of life for hemifacial spasm patients significantly improved after surgery with p < 0.05. We concluded that the minimally invasive retrosigmoid approach is a safe and effective surgical technique that can be employed in the treatment of trigeminal neuralgia and hemifacial spasm. The use of an endoscopic system during surgery provides high-resolution intraoperative imaging, facilitating access to deep, hidden, and narrow regions within the cerebellopontine angle that is difficult to reach with traditional surgical techniques while minimizing brain retraction.
Article Details
Keywords
Keyhole retrosigmoid approach, CPA, trigeminal neuralgia, hemifacial spams
References
2. Feng BH, Zhong WX, Li ST, et al. Fully endoscopic microvascular decompression of the hemifacial spasm: our experience. Acta Neurochir (Wien). 2020;162(5):1081-1087. doi:10.1007/S00701-020-04245-5
3. Ricci G, Di Stadio A, D’Ascanio L, et al. Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience. Braz J Otorhinolaryngol. 2019;85(4):465-472. doi:10. 1016/J.BJORL.2018.03.015
4. Guo X, Zhang C, Li Y, et al. Fully Endoscopic Microvascular Decompression for Hemifacial Spasm Using Improved Retrosigmoid Infrafloccular Approach: Clinical Analysis of 81 Cases. Oper Neurosurg (Hagerstown). 2022;23(1):40-45. doi:10.1227/ONS.0000000000000221
5. Holste K, Sahyouni R, Teton Z, et al. Spasm Freedom Following Microvascular Decompression for Hemifacial Spasm: Systematic Review and Meta-Analysis. World Neurosurg. 2020;139:e383-e390. doi:10.1016/j.wneu.2020.04.001
6. McGahan BG, Albonette-Felicio T, Kreatsoulas DC, et al. Simultaneous Endoscopic and Microscopic Visualization in Microvascular Decompression for Hemifacial Spasm. Oper Neurosurg (Hagerstown). 2021;21(6):540-548. doi:10.1093/ONS/OPAB348
7. Matmusaev M, Kumar R, Yamada Y, et al. Endoscopic Microvascular Decompression for Hemifacial Spasm. Asian J Neurosurg. 2020;15(4):833-838. doi:10.4103/AJNS.AJNS_ 152_20
8. Phạm Hoàng Anh, Dương Đại Hà, Chu Thành Hưng, và cs. Kết quả điều trị vi phẫu thuật bệnh lí co giật mặt với nội soi hỗ trợ tại Bệnh viện Việt Đức. Tạp chí Nghiên cứu Y học. 2023;162(1):37-45.
9. Wabbels B, Yaqubi A. Validation of a new hemifacial spasm grading questionnaire (HFS score) assessing clinical and quality of life parameters. J Neural Transm (Vienna). 2021;128(6):793-802. doi:10.1007/S00702-021 -02343-X
10. Halpern CH, Lang SS, Lee JYK. Fully endoscopic microvascular decompression: our early experience. Minim Invasive Surg. 2013;2013. doi:10.1155/2013/739432
11. Cheng WY, Chao SC, Shen CC. Endoscopic microvascular decompression of the hemifacial spasm. Surg Neurol. 2008;70Suppl1(SUPPL.1). doi:10.1016/J.SUR NEU.2008.02.024
12. Teo C, Nakaji P, Mobbs RJ. Endoscope-assisted microvascular decompression for trigeminal neuralgia: technical case report. Neurosurgery. 2006;59(4Suppl2). doi:10.1227/01.NEU.0000232768.47615.82
13. Magnan J, Caces F, Locatelli P, et al. Hemifacial spasm: endoscopic vascular decompression. Otolaryngol Head Neck Surg. 1997;117(4):308-314. doi:10.1016/S0194-5998 (97)70118-9
14. Chaudhry N, Srivastava A, Joshi L. Hemifacial spasm: The past, present and future. J Neurol Sci. 2015;356(1-2):27-31. doi:10.1016/J.JNS.2015.06.032
15. Kaufmann AM, Price A V. A history of the Jannetta procedure. J Neurosurg. 2019;132(2):639-646. doi:10.3171/2018.10.JN S181983
16. McLaughlin MR, Jannetta PJ, Clyde BL, et al. Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg. 1999;90(1):1-8. doi:10.3171/JN S.1999.90.1.0001
17. Lang SS, Chen HI, Lee JYK. Endoscopic microvascular decompression: a stepwise operative technique. ORL J Otorhinolaryngol Relat Spec. 2012;74(6):293-298. doi:10.1159/000342795
18. Komatsu F, Imai M, Hirayama A, et al. Endoscopic Microvascular Decompression with Transposition for Trigeminal Neuralgia and Hemifacial Spasm: Technical Note. J Neurol Surg A Cent Eur Neurosurg. 2017;78(3):291-295. doi:10.1055/S-0036-1592077
19. Komatsu F, Imai M, Matsumae M. How I do it: endoscopic microvascular decompression for hemifacial spasm associated with the vertebral artery. Acta Neurochir (Wien). 2018;160(1):157-159. doi:10.1007/S00701-017 -3392-9.