The "ePTFE Sleeve" for Microvascular Decompression of the Facial Nerve

World Neurosurg. 2022 Aug:164:240. doi: 10.1016/j.wneu.2022.05.019. Epub 2022 May 13.

Abstract

Hemifacial spasm is a cranial nerve compression syndrome caused by the anteroinferior cerebellar artery (AICA) and posteroinferior cerebellar artery (PICA), characterized by involuntary tonic/clonic contractions of the muscles. The refractory hemifacial spasm can be treated with microvascular decompression, and multivessel compression could require more than conventional microvascular decompression. Multivessel compression may be challenging, and placement of conventional materials may not be sufficient and risks migration. Some transposition techniques for the vertebral artery may even increase the risk of injuring some perforators. Our circumferential expanded polytetrafluoroethylene (ePTFE) (IMPRA, Tempe, Arizona, USA) sleeve technique is unique and accessible, and it could solve this issue. The 2-dimensional Video 1 demonstrates the case of a 38-year-old woman who presented with debilitating left hemifacial spasm for 11 years. On physical examination, she exhibited involuntary, recurrent twitches of left facial muscles and loss of sensory taste. Magnetic resonance imaging revealed touching of the left dominance dolicoectasic vertebral artery, with compression of the PICA and AICA over cranial nerve VII. Conservative measures were recommended. Nevertheless, progressive worsening symptoms presented despite botulinum toxin injections. Left retrosigmoid craniotomy was performed, first placing a 3/4 ePTFE sleeve for decompression of the cisternal portion and the second ePTFE sleeve at the root entry zone of cranial nerve VII to optimize decompression of the offending vessel. In this case, we decided to use ePTFE prosthetic material. The semirigidity and semielastic property force brings an adequate decompression of the nerve and isolates it from the offending artery (AICA-PICA and vertebral artery). Without an uneventful postoperative course, the patient remained neurologically intact with immediate recovery after surgery without facial spasms or facial paresis. At 14 months' follow-up, the patient was without any alteration. The circumferential ePTFE Sleeve is an effective option for microvascular decompression. This technique offers semielastic continuous isolation of the nerve keeping it away from the offending artery. In addition, the circumferential ePTFE fit between neurovascular structures could avoid migration out of position. No cases using this technique have been reported; beyond that, we would like to illustrate this procedure, which is not widely available as a video article.

Keywords: Facial nerve; Microvascular decompression; Prothesic material; Retrosigmoid approach; ePTFE.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Adult
  • Facial Nerve / diagnostic imaging
  • Facial Nerve / pathology
  • Facial Nerve / surgery
  • Female
  • Hemifacial Spasm* / diagnostic imaging
  • Hemifacial Spasm* / etiology
  • Hemifacial Spasm* / surgery
  • Humans
  • Microvascular Decompression Surgery* / methods
  • Polytetrafluoroethylene
  • Treatment Outcome

Substances

  • Polytetrafluoroethylene