Microvascular Decompression for Hemifacial Spasm: Diagnosing Relief
By Admin | June 01, 2023
According to the CDC, “social isolation significantly increased a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity.” What kinds of factors drive social isolation? One of them is physical impairment.
In this case, a 64 year old female’s facial twitch was so debilitating that it prevented her from engaging in social activities. The CDC also notes that age is a risk factor for loneliness stating, “there is strong evidence that many adults aged 50 and older are socially isolated or lonely in ways that put their health at risk.”
If the combination of debilitating facial twitches, social isolation, and increased risk of premature death weren’t concerning enough, the mouth and eye twitches she experienced also kept her awake at night. Adding the psychological effects of a lack of sleep into the mix, it’s clear this patient was facing significant challenges.
Abnormal spams and ticks like these can be caused by a blood vessel pumping on the facial nerve. So how can our patient find relief? By separating the blood vessel from the nerve and adding some cushioning to keep them separated permanently, a surgical team can perform a microvascular decompression, as was the plan for this patient. The abnormal muscle response that causes the twitch can be detected by intraoperative neuromonitoring (IONM), helping the surgical team identify the blood vessel and nerve responsible and when the abnormal response is resolved.
"Intraoperative monitoring helps with proper identification of neurological tissue which allows surgeons the ability to improve patient outcomes ,” said Kathryn Overzet Jaquez, VP of Clinical Development at Axis Neuromonitoring in Richardson, TX.
For this microvascular decompression, the neuromonitoring team used a variety of IONM modalities to promote the best outcome. Measurement of the abnormal muscle response and brainstem and cranial nerve function were closely monitored. To do this, the team employed the use of somatosensory evoked potentials, cranial nerve motor evoked potentials, electromyography and brainstem auditory evoked potentials.
What would this surgery look like without intraoperative neurophysiology? Neuromonitoring confirmed that the problem site addressed by the surgical team relieved the patient’s symptoms and that no further problem sites were lurking at other locations ff the nerve. Stable potentials indicated that brainstem and cranial nerve function remained intact despite retraction needed to access the problem site,
Thanks to IONM, the surgeon was confident that the patient’s issues were addressed without damaging nearby structures.. Cranial nerves were identified with direct stimulation, and upon detethering the facial nerve from the surrounding arachnoid, the abnormal muscle response resolved.
The resolution of the abnormal muscle response confirmed that the treatment was effective and stable responses indicated that no harm to the brainstem was encountered.
Axis Neuromonitoring provides high-quality intraoperative neurophysiological monitoring (IONM). For more information about neuromonitoring and how our practices create the best patient outcomes, call 888-344-2947 or visit https://www.axisneuromonitoring.com.
