Lumbar Endoscopic Unilateral Laminotomy With Bilateral Decompression Surgery in Severe Lumbar Stenosis Under Electrophysiological Monitoring-Focused on Full-Visualized Trephine/Osteotome.

OBJECTIVE: Although endoscopic drill has the advantages in manipulation and hemostasis, whose low efficiency and blurred vision reduce the efficacy of lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD). The present study was designed to evaluate the safety and efficacy of full-visualized trephine/osteotome in the LE-ULBD surgery for severe lumbar stenosis. METHODS: Fifty-seven severe lumbar stenosis patients who underwent LE-ULBD between January 2020 to January 2023 were enrolled, who were divided into drill and visualized trephine groups. The medical records including demographics, operative duration, intraoperative electrophysiological findings, postoperative hospital stay or hospital stay, postoperative outcomes and complications were retrospectively reviewed and analyzed. RESULTS: A total of 57 patients included 15 in drill and 42 in trephine group were enrolled in the study. There was significant difference in the pre- and postoperative visual analogue scale and Oswestry Disability Index scores in both groups (p < 0.05). The mean operative duration in the trephine group (101.05 ± 12.18 minutes) was shorter than that in the drill group (134.67 ± 9.68 minutes) (p < 0.05). There was no statistical difference between the 2 groups in electrophysiological monitoring, posthospital stays, postoperative outcomes and complications. Abnormal free-electromyography (EMG) were recorded in 2 (13.3%) and 5 patients (11.9%) in the drill and trephine group. Intraoperative somatosensory evoked potential changes occurred in 3 (20%) and 3 patients (7.1%) in the drill and trephine group and all patients recovered immediately when surgery ended. No serious complications and recurrence occurred in all the patients. CONCLUSION: Full-visualized trephine/osteotome has been approved to be convenient, safe and efficient in our study, which combined with translaminar inside-out technique and EMG monitoring especially free-EMG may offer a new choice in LE-ULBD surgery for lumbar stenosis patients.

A Comparative Review of the Outcome Following MVD and PBC in Patients with Trigeminal Neuralgia.

BACKGROUND: This study aims to systematically review the treatment outcomes of percutaneous balloon compression (PBC) and microvascular decompression (MVD) in patients with trigeminal neuralgia. METHODS: A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was performed using PubMed, Embase, and Cochrane Central Registry of Controlled Trials databases. Only those articles with more than 5 years' follow-up length were included in this investigation. To uniformly assess the postoperative outcome, we defined pain relief as totally pain free, while the postoperative hospitalization and last follow-up period were defined as early and long term, respectively. The facial numbness was quantified with Barrow Neurological Institute Pain Intensity Score (BNI). RESULTS: After database searching and screening, 7,797 cases were finally included according to the criteria. The early pain relief rates were 94.1% (1,551/1,649) and 89.9% (4,962/5,482) following PBC and MVD (odds ratio [OR] = 0.603; p < 0.05), while the long-term rates were 58.1% (921/1,566) and 74.9% (4,549/6,074; OR = 2.089; p < 0.05), respectively. Although a significant higher facial numbness occurred in the PBC group in the early stage, it was mostly diminished 5 years later compared with the MVD group. At long-term follow-up, hypoacusis and facial palsy occurred more often in the MVD group (p < 0.05). CONCLUSIONS: Both MVD and PBC provide a satisfactory outcome for the patients in the long term. As a simple, safe, and reliable technique, PBC should be considered as a viable alternative.

Microvascular decompression for pediatric-onset hemifacial spasm: case series and literature review.

OBJECTIVES: Pediatric hemifacial spasm has been rarely reported in the literature, which contains only 44 cases. Although microvascular decompression (MVD) has been widely regarded as effective therapy for hemifacial spasm, the etiology and surgical treatment of pediatric patients are seldom reported. We report our experience with MVD for pediatric hemifacial spasm patients and review the literature with emphasis on the difference from adults. METHODS: This retrospective report included 4 pediatric HFS patients, who underwent MVD in our department between January 2014 and May 2021 and then reviewed all the pediatric hemifacial spasm literature on "pubmed" with emphasis on the clinical data. RESULTS: Our series included 1 boy and 3 girls with an average age of 15.6 ± 3.2 years old; their onset ages were from 7 to 16 years old (11.6 ± 4.3). Three patients achieved immediate excellent outcomes and 1 achieved poor immediately and became good 6 months later. During the operation, all the 4 patients were found compressed by anterior inferior cerebellar artery (AICA). The incidence of pediatric atypical hemifacial spasm patients is 12.5% among the 48 reported cases, which is much higher than adults. Among all the reported 48 cases including ours, the singular artery neurovascular conflictions account for 27/48(56%), the singular vein and combined artery/vein conflictions in 12/48(25%) and the cisternal conflictions in 5/48(10.4%) patients. CONCLUSIONS: The etiology of pediatric hemifacial spasm is still neurovascular conflict, of which combined artery/vein and singular venous compression patterns have a higher proportion, which might explain higher incidence of pediatric atypical hemifacial spasm and less favorable postoperative outcome. Sufficient arachnoid release, full exploration and decompression along the facial nerve are necessary, which would help to increase the excellent postoperative cure rate among pediatric patients.

Microvascular decompression for pediatric onset trigeminal neuralgia: patterns and variation.

OBJECTIVES: Pediatric trigeminal neuralgia has been rarely reported in the literature, which were only 28 cases. Although microvascular decompression (MVD) has been widely accepted as effective therapy for trigeminal neuralgia, the etiology and surgical treatment of pediatric ones are seldom addressed. We report our experience with MVD for pediatric trigeminal neuralgia patients with emphasis on the vascular conflict patterns and surgical skills. METHODS: This retrospective report included 11 pediatric TN patients, who underwent MVD and were followed for 3-86 months. The data were retrospectively analyzed with emphasis on the clinical features. RESULTS: This series included 4 boys and 7 girls with average age of 13 ± 3.4 years old, their onset age were from 7 to 18 years old. The singular vein and combined artery/vein conflictions account for 7/11. 9 (81.8%) patients achieved immediate excellent outcomes. One recurrence was observed after 5 months and refused the second surgery. CONCLUSIONS: The etiology of pediatric onset trigeminal neuralgia is still vascular conflict, whose patterns are different from adults, of which combined artery/vein and singular venous compression patterns have a much more higher proportion. Because of the smaller operative space and fragile-thin venous wall with adhesion to other structures, it is much more difficult to decompress the trigeminal nerve among pediatric patients. Sufficient arachnoid release, full exploration, and decompression along the trigeminal nerve were necessary, which will increase the excellent rate among pediatric patients.

Treatment of Trigeminal Neuralgia with "Microvascular Decompression Plus" Technique.

Objective Although microvascular decompression (MVD) has been widely accepted as an effective treatment of trigeminal neuralgia (TN), some patients have not been cured. To improve the postoperative outcome, the surgical procedure should be further refined. Design This is a retrospective study. Setting Present study conducted at a cranial nerve disorder center. Participants Clinical data were collected from patients with TN who had undergone surgery in our center, including 685 who had undergone traditional MVD and 576 who had undergone the "MVD plus" procedure, in which any vessel attached to the trigeminal nerve was freed away ("nerve-combing"), which was followed by intraoperative neurolysis. Main Outcome Measures Postoperative outcomes and complications in the two groups were compared. Results Among patients who underwent traditional MVD, the rates of immediate relief and 1-year relief were 89.9 and 86.9%, respectively; among patients who underwent MVD plus group, these rates were 95.1 and 94.6%, respectively ( p = 0.05). Patients who underwent MVD plus initially exhibited a higher rate of facial numbness ( p < 0.05), but this finding decreased over time and reached the same level as that in the traditional MVD group within 3 months ( p > 0.05). Conclusion Sufficient MVD with nerve-combing for the treatment of TN may produce a high rate of cure with less recurrence.

IL-6 contributes to Nav1.3 up-regulation in trigeminal nerve following chronic constriction injury.

Background: To verify the hypothesis that the nature of trigeminal neuralgia (TN) is an ectopic impulse induced by sodium channel modulated by cytokines, we conducted an animal study using the infraorbital nerve chronic constriction injury (CCI) model in rats.Method: The expression of Nav1.3 or IL-6 in the infraorbital nerve (ION) and trigeminal ganglion (TG) were detected by western blot and immunocytochemistry after administration of antisense oligodeoxynucleotide sequence (AS), IL-6 or Anti-IL-6.Results: With intrathecal administration of AS or mismatch oligodeoxynucleotide sequence (MM) in the CCI rats, the Nav1.3-IR in ION and TG accounted for 2.2 ± 0.51% and 8.5 ± 3.1% in AS+CCI group vs. 6.9 ± 1.3% and 38.7 ± 4.8% in MM+CCI group (p < 0.05), respectively. While with local administration of IL-6 in those with sham operation, it accounted for 7.4 ± 2.1% and 45.5 ± 3.4% in IL-6+ sham group vs. 1.9 ± 0.67% and 8.1 ± 1.3% in vehicle+sham group (p < 0.05); with local administration of anti-IL-6 in CCI rats, 4.5 ± 0.78% and 32.1 ± 9.6% in Anti-IL-6+ CCI group vs 8.9 ± 2.1% and 61.4 ± 11.2% in vehicle+CCI group (p < 0.05).Discussion: We believe that the emergence of Nav1.3 from the compressed trigeminal nerve might be an important structural basis for the development of the ectopic excitability on the axon and IL-6 may play a role of necessary precondition.

Is it necessary to approach the compressed vertebra bilaterally during the process of PKP?

OBJECTIVE: To assess the clinical and radiological outcomes following unilateral or bilateral approach in percutaneous kyphoplasty (PKP) for treatment of osteoporotic vertebral compression fractures (OVCF). DESIGN: Prospective comparative study. SETTING: University affiliated hospital. PARICIPANTS: From 2012 through 2016, those MRI-diagnosed single-level lumbar OVCF patients. INTERVENTIONS: They were randomly assigned for treatment with unilateral or bilateral PKP. OUTCOME MEASURES: We assessed the patient' health status with the Oswestry Disability Index (ODI) questionnaire. Anteroposterior and lateral standing radiographs were obtained to measure the vertebral height and kyphotic angle of the vertebral body in all patients. RESULTS: Eighty-five patients were finally enrolled in this investigation, including 42 in the unilateral and 43 in the bilateral group. The operation time, PMMA volume, radiation dose was 25.6 ± 4.2 minutes, 6.2 ± 3.5 ml and 0.88 ± 0.28 mSv in the unilateral group, while 36.6 ± 8.7 minutes, 8.5 ± 2.2 ml and 1.89 ± 1.05 mSv in the bilateral group, respectively (P < 0.05). The postoperative VAS and ODI were 2.7 ± 1.2 and 19.8 ± 6.4 compared to preoperative 8.7 ± 1.6 and 35.2 ± 4.3 in unilateral group, while 2.6 ± 1.3 and 19.7 ± 2.6 compared to preoperative 8.5 ± 1.3 and 36.7 ± 3.6 in bilateral group, respectively (P > 0.05). CONCLUSION: Both bilateral and unilateral PKP are relatively safe and provide effective treatment for patients with painful OVCF. However, unilateral PKP need less radiation dose, operation time and PMMA volume.

A correlative analysis between inflammatory cytokines and trigeminal neuralgia or hemifacial spasm.

BACKGROUND: It is necessary to understand the mechanism of trigeminal neuralgia (TN) and hemifacial spasm (HFS) in order to seek for an effective noninvasive remedy. As previous studies implied that inflammatory cytokines induced by demyelination following the nerve injury may be the initiated factor causing neuropathic pain, we attempt to analyze the correlation between cytokines and these hyperactive cranial nerve disorders. METHOD: The consecutive patients whose diagnosis were confirmed by microvascular decompression surgery as primary TN or HFS caused by vascular compression and healthy volunteers between March and May 2018 in XinHua Hospital Shanghai JiaoTong University School of Medicine were recruited. Preoperatively, venous blood was collected and the protein concentrations of IL-1ß, IL-2, IL-6, IL-8, IL-10, TNF-α and IFN-γ were determined with ELISA. Each cytokine was compared between the patients and healthy volunteers. RESULTS: Ultimately, 28 healthy volunteers as well as 44 TN and 47 HFS patients were enrolled in this investigation. The serum levels of IL-1ß, IL-6, IL-8 and TNF-α in either HFS or TN patients were significantly higher than that in healthy volunteers (p < 0.05), yet which were similar between TN and HFS patients (p > 0.05). Besides, there was a significantly correlation between IL-6 concentration and severity of HFS (r = 0.933, p < 0.05) or TN (r = 0.943, p < 0.05). DISCUSSION: Vascular compression of trigeminal or facial nerve roots may induce a rise in variety of cytokines, and IL-6 may play an important role in the signaling pathways to generate ectopic impulses from these cranial nerves.

Pain threshold monitoring during chronic constriction injury of the infraorbital nerve in rats.

Background: The chronic constriction injury (CCI) of the infraorbital nerve (ION) has been used to establish an animal mode of trigeminal neuralgia (TN), but key parameters of the model have not been quantified until now. Objective: The aim of the study was to quantify a standard of pain threshold to evaluate a successful TN model in Sprague-Dawley (SD) rats. Methods: Forty-eight adult SD rats (200-220 g) underwent chronic constriction injury of the infraorbital nerve. The pain threshold was tested one day preoperatively (baseline) and day 1, 3, 7, 14, 28 postoperatively using the up-down method. At day 28, all the animals were killed by dislocation of the cervical spine and the trigeminal nerve specimens were removed for electron microscopy. Results: The baseline pain threshold was 14.40 ± 0.87 g. Postoperatively, all the rats presented an initial reduced sensitivity to mechanical stimulation from day 1 (15.63 ± 1.92 g) through 7 (17.39 ± 1.43 g) after the surgery. At day 14, 32 (66.7%) began to show significant mechanical allodynia (0.71 ± 0.43 g) which did not change significantly till day 28 (0.88 ± 0.54 g). These animals were regarded as successful TN models with a 95% confidence interval of the pain threshold of 0.58-1.27 at Day 14. The electron microscopy demonstrated homogeneously demyelinated changes in those successful TN model animals rather than severe or mild epineurial lesions in those unsuccessful model animals. Conclusion: Our study showed that an animal TN model could be established with a two-week chronic constriction injury of the infraorbital nerve. The mechanical allodynia index <1.27 at Day 14 was suggested as a criterion for a successful model.

What Should We Do for Those Hemifacial Spasm Patients Without Efficacy Following Microvascular Decompression: Expectation of Delayed Relief or Early Reoperation?

BACKGROUND: Although microvascular decompression (MVD) has been widely accepted as an effective treatment for hemifacial spasm (HFS), some patients may experience delayed relief instead of immediate improvement after the surgery. The need for and timing of repeat MVD has been controversial to date; thus, we conducted the present study with emphasis on those unrelieved patients. METHODS: Between January 2010 and December 2014, 3095 patients with idiopathic HFS were treated with MVD at XinHua Hospital, Shanghai Jiaotong University School of Medicine. Among these patients, 174 (5.6%) reported no symptom relief. Those patients without immediate relief were the focus of this study, and all were reevaluated at 2 years after MVD surgery. RESULTS: Among these 174 patients, 96 underwent redo MVD within 1 week of the first procedure (early MVD redo group), 19 underwent redo between 3 and 12 months after the first procedure (late MVD redo group), and 59 were observed (observation group). In the early redo MVD group, immediate improvement was reported by all patients except 1, who did not experience symptom relief until 3 months later. In the later redo MVD group, immediate symptom improvement was reported by 14 of 19 patients. By the end of the 2-year follow-up period, 1 recurrence occurred in the early redo MVD group, no changes occurred in the later MVD group, and 9 patients improved in the observation group. Ultimately, the final rates of symptom relief were 99.0% in the early redo MVD group, 73.7% in the later redo MVD group, and 15.3% in the observation group (P < 0.01). In the early redo MVD group, postoperative courses showed no significant differences between the first and the second operations. In the later redo MVD group, 1 patient developed a mild facial palsy and 1 had a cerebrospinal fluid leak. CONCLUSIONS: Our findings demonstrate that MVD is the most effective treatment for patients with HFS. An early reoperation is easier and safer than a later reoperation and may improve the likelihood of immediate relief.

Microvascular decompression for glossopharyngeal neuralgia: a retrospective analysis of 228 cases.

BACKGROUND: Glossopharyngeal neuralgia (GPN) is an uncommon craniofacial pain syndrome caused by neurovascular conflict. Compared to trigeminal neuralgia or hemifacial spasm, the incidence of GPN was very low. Until now, little is known about the long-term outcome following microvascular decompression (MVD) process. METHODS: Between 2006 and 2016, 228 idiopathic GPN patients underwent MVD in our department. Those cases were retrospectively reviewed with emphasis on intraoperative findings and long-term postoperative outcomes. The average period of follow-up was 54.3 ± 6.2 months. RESULTS: Intraoperatively, the culprit was identified as the posterior inferior cerebellar artery (PICA) in 165 cases (72.3%), the vertebral artery (VA) in 14 (6.1%), vein in 10 (4.4%), and a combination of multiple arteries or venous offending vessels in 39 (17.2%). The immediately postoperative outcome was excellent in 204 cases (89.5%), good in 12 (5.3%), fair in 6 (2.6%) and poor in 6 (2.6%). More than 5-year follow-up was obtained in 107 cases (46.9%), which presented as excellent in 93 (86.9%), good in 6 (5.6%), fair in 3 (2.8%) and poor in 5 (4.7%). Thirty-seven (16.2%) of the patients experienced some postoperative neurological deficits immediately, such as dysphagia, hoarseness and facial paralysis, which has been improved at the last follow-up in most cases, except 2. CONCLUSIONS: This investigation demonstrated that MVD is a safe and effective remedy for treatment of GPN.

Anterior Cervical Discectomy and Fusion with a Compressive C-JAWS Staple.

BACKGROUND: Anterior cervical discectomy and fusion is currently the most commonly used technique in cervical surgery. But the implantation of a traditional plate is time-consuming and exposes the patient to additional adverse events. In this study, we analyzed results in patients who underwent anterior cervical discectomy and fusion with C-JAWS fixation. The C-JAWS device is a new cervical compressive staple developed to stabilize the spacer. METHODS: At our department, between January 2012 and December 2013, nine consecutive patients with cervical spondylopathy underwent an anterior cervical discectomy and fusion process in which we used a polyether ether ketone cervical spacer prefilled with bone substitute and secured with a cervical compressive staple. The Neck Disability Index (NDI) score and visual analog score (VAS) for neck and arm pain, as well as radiographic examinations, were adopted to assess postoperative outcome and fusion. RESULTS: Bony fusion was observed in all of the nine patients, and no serious surgery-related or implant-related complications were observed during the operation or in the postoperative period. The average operative time was 60.3 ± 11.6 min. The average hospital stay was 3.2 ± 0.8 days. The average skin incision length was 3.0 ± 0.3 cm. The average follow-up was 18.4 ± 4.3 months. At the last follow-up, the NDI had changed from the baseline value of 23.4 ± 10.3 to 7.1 ± 4.8, and the VAS values for neck and arm pain had changed from 6.1 ± 1.0 and 4.6 ± 1.6,respectively, to 2.3 ± 1.7 and 2.4 ± 1.1, respectively. The patients' subjective satisfaction was excellent in six and good in three. CONCLUSIONS: Without screws, this low-profile design compressive staple, the C-JAWS, performed well in anterior cervical discectomy and fusion surgeries.

The Significance of Abnormal Muscle Response Monitoring During Microvascular Decompression for Hemifacial Spasm.

BACKGROUND: Despite the wide adoption of the abnormal muscle response (AMR) to electrical stimulation of the facial nerve during microvascular decompression (MVD) surgery, the value of AMR in the prognosis of the postoperative outcome is still controversial. In order to better use this intraoperative electrophysiology, it is necessary to further address the relationship between AMR and postoperative results. METHODS: Three hundred and thirty-two patients with hemifacial spasm (HFS) in whom MVD surgery was performed and in whom AMR was available were finally enrolled in this study. The intraoperative AMR changes were classified as amplitude ≥ 50 %, <50 %, and disappearance. These changes were retrospectively analyzed in association with intraoperative findings and postoperative outcomes. The follow-up period ranged from 11 to 62 months, with an average of 34.1 months. RESULTS: Among the 332 patients with a typical AMR wave recorded at the beginning of the operation, the AMR disappeared in 305, and amplitude was <50 % in 11 and ≥50 % in 16. Of those with AMR disappearance plus those with amplitude < 50 %, 98.4 % achieved relief on the first postoperative day and at the latest follow-up, while of those with amplitude ≥50 %, 18.8 % and 25 %, respectively, achieved relief on the first postoperative day and at the latest follow-up (P < 0.01). Accordingly, a more than 50 % decrease of AMR amplitude may predict a good prognosis. The accuracy, sensitivity, and specificity of AMR monitoring were 97.5 %, 99 %, and 72.2 %, respectively. CONCLUSIONS: AMR could be a good tool for successful MVD in patients with HFS when a rational analysis is conducted in association with the intraoperative findings. Persistence of AMR may imply that the real offending vessel was missed. If the entire facial nerve root is cleared of any vessel, a remaining AMR amplitude of less than 50 % might be acceptable. Otherwise, neurocombing is suggested before finishing the operation.

One-Pot Aqueous Synthesization of Near-Infrared Quantum Dots for Bioimaging and Photodynamic Therapy of Gliomas.

BACKGROUND: As the early detection and total destruction of gliomas are essential for longer survival, we attempted to synthesize a quantum dot (QD) that is capable of recognizing glioma cells for imaging and photodynamic therapy. METHODS: Using a one-pot aqueous approach, near infrared-emitting CdTe was produced. After detection of its physicochemical characteriistics, it was conjugated with RGD. The emission images were observed with confocal microscopy. To test its toxicity, CdTe-RGD at various concentrations was separately added to a human glioma cell line (U251) and a mouse embryo fibroblast cell line (3T3) (control) for incubation in dark conditions. To test its photodynamic effect, the U251 and 3T3 cells were then irradiated for 5-60 min, using a 632.8-nm laser. RESULTS: This QD (Φ = 3.75 nm, photoluminescence (PL) peak wavelength = 700 nm, photoluminescence quantum yield (PLQY) = 20 %), was a spherical crystal with excellent monodispersity. Under a confocal microscope, U251 cells were visualized, but not the 3T3 cells. In dark conditions, the survival rates of both U251 and 3T3 cells were above 85 %. After laser irradiation, the survival rate of U251 cells decreased to 37 ± 1.6 % as the irradiation time and the CdTe-RGD concentration were increased. CONCLUSIONS: With good physicochemical characteriistics and low toxicity, this QD-RGD has broad prospects for use in the biomedical imaging and photodynamic therapy of gliomas.

Fatal complications following microvascular decompression: could it be avoided and salvaged?

Although the microvascular decompression (MVD) surgery has become an effective remedy for cranial nerve rhizopathies, it is still challengeable and may result in a fatal sequel sometimes. Therefore, the operative skill needs to be further highlighted with emphasis on the safety and a preplan for management of postoperative fatal complications should be established. We retrospectively analyzed 6974 cases of MVD. Postoperatively, 46 patients (0.66 %) presented decline in consciousness with a positive finger-nose test (or failure to be tested) after wake up from the anesthesia, whom were focused on in this study. Their surgical findings and intraoperative manipulation as well as computer tomography (CT) delineation were reviewed in detail. These cases consisted of trigeminal neuralgia in 37 and hemifacial spasm in 9. All these patients underwent an immediate CT scan, which demonstrated cerebellar hemorrhages in 38 and epidural hematomas in 6. A later magnetic resource image delineated cerebral infarctions in basal ganglia in 2. Eventually, 15 (0.2 %) died and 31 survived. Data analysis showed that the mortality is significantly higher in trigeminal cases with cerebellar hematoma and an immediate hematoma evacuation plus ventricular drainage could give the patient more chance of survival (p < 0.05). It appeared that the cerebellar hemorrhage was the predominant cause contributable to the postoperative consciousness decline, which occurred more often in trigeminal cases. To have a safe MVD, an appropriate surgical technique is the priority. It is very important to create a satisfactory working space before decompression of the cranial nerve root, which is obtained by a patient microdissection of the arachnoids rather than blind retraction of the cerebellum and hotheaded sacrifice of the petrous vein. Once a cerebellar hematoma is confirmed, an emergency surgery should not be hesitated. A prompt evacuation of the hematomas followed by a dual ventricular drainage via both the frontal horns may save the patient.

Anterior cervical discectomy and fusion with a compressive staple of C-JAWS.

OBJECTIVE: To evaluate the clinical value of C-JAWS in anterior cervical discectomy and fusion (ACDF) surgery. METHODS: Between January 2012 and December 2013, nine consecutive patients with cervical spondylopathy underwent ACDF process using a polyetheretherketone cervical spacer prefilled with bone substitute and secured by a cervical compressive staple in our department. The Neck Disability Index (NDI) score and visual analogy scale (VAS) of neck or arm pain as well as radiographic examination were adopted to assess the postoperative outcome and fusion. RESULTS: Bony fusion was observed in all of the nine patients, and no serious surgery-related or implant-related complications were observed during the operation or postoperative period. The average operative time was 60.3 ± 11.6 min. The average hospital stay was 3.2 ± 0.8 days. The average skin incision length was about 3.0 ± 0.3 cm. The average of the follow-up days was 18.4 ± 4.3 months. At the last follow-up, the NDI changed from the baseline of 23.4 ± 10.3 to 7.1 ± 4.8, the VAS of neck or arm pain from 6.1 ± 1.0 and 4.6 ± 1.6 to 2.3 ± 1.7 and 2.4 ± 1.1, respectively. The patients' subjective satisfaction was excellent in 6 and good in 3. CONCLUSIONS: Without screws, this low-profile designed compressive staple C-JAWS performed well in the ACDF surgeries.

Teflon Might Be a Factor Accounting for a Failed Microvascular Decompression in Hemifacial Spasm: A Technical Note.

BACKGROUND: Although Teflon is widely adopted for microvascular decompression (MVD) surgery, it has never been addressed for failure analysis. This study analyzed the reasons for failed MVDs with emphasis on the Teflon sponge. METHODS: Among the 685 hemifacial spasm cases between 2010 and 2014, 31 were reoperated on within a week because of unsatisfactory outcome, which was focused on in this study. Intraoperative findings regarding Teflon inserts of these repeat MVDs were reviewed. RESULTS: Among the 38 without satisfactory outcomes, 31 underwent repeat MVDs, and they were all spasm free afterwards. Eventually, the final cure rate was 99.2%. It was found in the repeat MVDs that the failure was attributable to the Teflon insert in most of the cases (74.2%) directly or indirectly. It was caused by improper placement (47.8%), inappropriate size (34.8%) and unsuitable shape (17.4%) of the Teflon sponge. CONCLUSION: Although it is not difficult for an experienced neurosurgeon to discover a neurovascular conflict during the MVD process, the size, shape and location of the Teflon sponge should not be ignored. Basically, the Teflon insert is used to keep the offending artery away from the facial nerve root rather than to isolate it. Therefore, the ideal Teflon sponge should be just small enough to produce a neurovascular separation.

Management of symptomatic hemifacial spasm or trigeminal neuralgia.

Hemifacial spasm (HFS) or trigeminal neuralgia (TN) is a kind of hyperactivity disorder of cranial nerves caused by vascular compression. However, sometimes, the disease may arise from nerve damage produced by tumors, which was called as symptomatic HFS/TN. Until now, little is known about the exact mechanism and the necessity of microvascular decompression (MVD) regarding the tumor-induced HFS/TN, which is necessary to be retrospectively analyzed in a considerable sample. Among the 4021 patients who underwent MVD in our department between 2006 and 2014, 44 were finally diagnosed as symptomatic HFS or TN. These patients were focused in this study and their clinical features as well as intraoperative findings and postoperative outcomes were retrospectively investigated. Data analysis exhibited the symptomatic HFS/TN cases accounted for 1.1 % in the study, which were caused by epidermoid in 18 (40.9 %) and meningioma in 15 (34.1 %) followed by neuroma in 7 (15.9 %) as well as aneurysm in 2 (4.5 %) and arteriovenous malformation in 2 (4.5 %). Compared to those with idiopathic HFS/TN, younger females were more susceptible (p < 0.05). After resection of the neoplasm, the offending vessel was identified in 26 (59.1 %), which were followed by MVD process. Postoperatively, the symptoms relief rate was 88.6 %. Our study showed that surgical management of patients with symptomatic HFS/TN may lead to a satisfactory result, yet those primary lesions should be removed firstly. In some cases, a microvascular decompression process might be unnecessary afterward, but the entire nerve root should be checked to exclude any vessel in contact with.

Management of Bilateral Hemifacial Spasm with Microvascular Decompression.

BACKGROUND: Bilateral hemifacial spasm (HFS) is very rare. The literature contains only 32 clinical reports. Although microvascular decompression (MVD) is widely accepted as effective therapy for HFS, the etiology and surgical treatment of bilateral HFS are seldom addressed. We report our experience with MVD for patients with bilateral HFS. METHODS: This retrospective report included 10 patients with bilateral HFS. All patients underwent MVD 1 or 2 times and were followed for 5-92 months. The clinical data were retrospectively analyzed. The etiology and treatment strategies were discussed. RESULTS: Spasm stopped completely on the operative side in all 10 patients. Symptoms on the other side also resolved in 3 patients, improved in 1 patient, and did not improve at all in 6 patients. Of the 6 patients with no improvement, 5 underwent another MVD on the contralateral side within 1 year and experienced relief of symptoms, and 1 patient refused the surgery. The neurovascular conflict was found in all the operations. During the follow-up period, no complications of hearing loss or facial palsy and no recurrence were observed. CONCLUSIONS: Vascular compression was the cause of bilateral HFS in our patients, and MVD relieved the symptoms. Thus, we recommend MVD for patients with bilateral HFS. A crowded cerebellopontine angle space and easy attrition of the neurovascular interfaces may play important roles in the occurrence of bilateral HFS. For some patients, 1 MVD can resolve bilateral symptoms.