Transposition of posterior inferior cerebellar artery could have caused ischemic complication in microvascular decompression for hemifacial spasm
Ischemic complications are generally rare complications in microvascular decompression surgery for hemifacial spasm. We report a case of posterior inferior cerebellar artery (PICA) infarction post-microvascular decompression. A 68-year old woman with a 2-year history of right hemifacial spasm underw...
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doaj-35f7f3a1cca743a3b4ae3850754307e32020-11-24T21:49:17ZengElsevierInterdisciplinary Neurosurgery2214-75192019-06-01162224Transposition of posterior inferior cerebellar artery could have caused ischemic complication in microvascular decompression for hemifacial spasmNaohide Fujita0Satoshi Adachi1Mario Suzuki2Yuzaburo Shimizu3Osamu Akiyama4Akihide Kondo5Department of Neurological Surgery, Juntendo University Faculty of Medicine, Tokyo, JapanDepartment of Neurological Surgery, Juntendo University Faculty of Medicine, Tokyo, JapanDepartment of Neurological Surgery, Juntendo University Faculty of Medicine, Tokyo, JapanDepartment of Neurological Surgery, Juntendo University Faculty of Medicine, Tokyo, JapanDepartment of Neurological Surgery, Juntendo University Faculty of Medicine, Tokyo, JapanCorresponding author at: 2-1-1 Hongo, Bunkyo-ku, 1138421 Tokyo, Japan.; Department of Neurological Surgery, Juntendo University Faculty of Medicine, Tokyo, JapanIschemic complications are generally rare complications in microvascular decompression surgery for hemifacial spasm. We report a case of posterior inferior cerebellar artery (PICA) infarction post-microvascular decompression. A 68-year old woman with a 2-year history of right hemifacial spasm underwent microvascular decompression surgery. Preoperative magnetic resonance image (MRI) showed that her PICA ran through closely to the root exit zone of her facial nerve. We treated the PICA with a string of polytetra fluoroethylene. After surgery, the patient complained about vertigo, and her MRI revealed ischemic changes in the medulla. She was eventually discharged without any neurological deficit. We reviewed our intraoperative video and found that certain steps in the detachment of the vessel, and minor changes in vessel position could have induced vascular obstruction and ischemia. Herein, we also discuss the choice of decompression methods and emphasize that the transposition of vessels was too invasive in this case. An appropriate method of decompression should carefully be performed in such cases, and review of surgical videos is beneficial. Keywords: Ischemic complications, Microvascular decompression, Hemifacial spasm, Transpositionhttp://www.sciencedirect.com/science/article/pii/S2214751918302573 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Naohide Fujita Satoshi Adachi Mario Suzuki Yuzaburo Shimizu Osamu Akiyama Akihide Kondo |
spellingShingle |
Naohide Fujita Satoshi Adachi Mario Suzuki Yuzaburo Shimizu Osamu Akiyama Akihide Kondo Transposition of posterior inferior cerebellar artery could have caused ischemic complication in microvascular decompression for hemifacial spasm Interdisciplinary Neurosurgery |
author_facet |
Naohide Fujita Satoshi Adachi Mario Suzuki Yuzaburo Shimizu Osamu Akiyama Akihide Kondo |
author_sort |
Naohide Fujita |
title |
Transposition of posterior inferior cerebellar artery could have caused ischemic complication in microvascular decompression for hemifacial spasm |
title_short |
Transposition of posterior inferior cerebellar artery could have caused ischemic complication in microvascular decompression for hemifacial spasm |
title_full |
Transposition of posterior inferior cerebellar artery could have caused ischemic complication in microvascular decompression for hemifacial spasm |
title_fullStr |
Transposition of posterior inferior cerebellar artery could have caused ischemic complication in microvascular decompression for hemifacial spasm |
title_full_unstemmed |
Transposition of posterior inferior cerebellar artery could have caused ischemic complication in microvascular decompression for hemifacial spasm |
title_sort |
transposition of posterior inferior cerebellar artery could have caused ischemic complication in microvascular decompression for hemifacial spasm |
publisher |
Elsevier |
series |
Interdisciplinary Neurosurgery |
issn |
2214-7519 |
publishDate |
2019-06-01 |
description |
Ischemic complications are generally rare complications in microvascular decompression surgery for hemifacial spasm. We report a case of posterior inferior cerebellar artery (PICA) infarction post-microvascular decompression. A 68-year old woman with a 2-year history of right hemifacial spasm underwent microvascular decompression surgery. Preoperative magnetic resonance image (MRI) showed that her PICA ran through closely to the root exit zone of her facial nerve. We treated the PICA with a string of polytetra fluoroethylene. After surgery, the patient complained about vertigo, and her MRI revealed ischemic changes in the medulla. She was eventually discharged without any neurological deficit. We reviewed our intraoperative video and found that certain steps in the detachment of the vessel, and minor changes in vessel position could have induced vascular obstruction and ischemia. Herein, we also discuss the choice of decompression methods and emphasize that the transposition of vessels was too invasive in this case. An appropriate method of decompression should carefully be performed in such cases, and review of surgical videos is beneficial. Keywords: Ischemic complications, Microvascular decompression, Hemifacial spasm, Transposition |
url |
http://www.sciencedirect.com/science/article/pii/S2214751918302573 |
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