Abstract
Background
The common trunk anomaly of the anterior and posterior inferior cerebellar artery (APC) is a variant artery that causes a hemifacial spasm (HFS). The anatomical characteristics include a large diameter of the trunk and the existence of the bifurcation near the facial nerve root entry zone (REZ). Despite APC being encountered at a constant rate in microvascular decompression (MVD), the anatomical and technical issues of transposing APC have not been entirely focused on yet.
Methods
We reviewed our 68 cases with APC involvement. Patient background, radiological findings, and operative video recordings were reviewed retrospectively. The location of the bifurcation of APC and the distribution of perforators were investigated. Surgical outcomes were assessed in the long term.
Results
APC involvement was diagnosed preoperatively in all cases by careful observation with MRI. Three-dimensional images determined the anatomical characteristics of APC and depicted the relationship with the facial nerve. All patients had a bifurcation close to the root entry zone that was required to transpose, including the common trunk and the distal branches, to achieve sufficient decompression. While adequate transposition from the REZ was accomplished in most cases, it was difficult to complete transposition due to short perforators in 6 patients (8.8%), resulting in interposition. Fifty-three patients (77.9%) became spasm free immediately after surgery, 66 patients (97.1%) were after 6 months, and all patients (100%) became spasm free within a year. Spasm-free status was maintained during the follow-up period (4.7 years) in all patients except one in whom facial spasm recurred 2 years after the initial surgery.
Conclusions
Transposing the common trunk with the bifurcation and distal branches contributes to obtaining favorable surgical outcomes in APC-related HFS.
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Acknowledgements
We thank Ms. Satomi Fujimura and Ms. Yasuko Noda for their assistance with data collection.
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All procedures performed in this study were in accordance with the ethical standards of our institutional committee, national research committee, and the 1964 Helsinki Declaration with its later amendments or comparable ethical standards. This study also obtained approval from the ethics committee of our institution. All data identifying the patients were anonymized. This article was conducted and described using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
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Comments
In this article, the authors have presented their great experience of the microvascular decompression for the hemifacial spasm caused by the common trunk anomaly of the anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA). As to surgical difficulties in these unique cases, they pointed out 1) the main bifurcation near the root exit zone of the facial nerve and 2) short perforators often from the AICA branches. In the cases with individual AICA and PICA, the AICA often gives off more short perforating arteries near the exit zone, as like they found in the common trunk cases.1 The PICA is easier to mobilize due to less and longer perforators, when its superior loop is encountered as the offending vessels. This research emphasized the importance of a detailed preoperative assessment and precise understanding of anatomical variation for secure decompression surgery, and we would like to congratulate the authors on their excellent surgical results and a very informative study.
Ken Matsushima, Toshio Matsushima, Japan
1: Matsushima K, Jiang X, Rhoton AL. Microsurgical Anatomy for Microvascular Decompression Surgery. In: Li ST, Zhong J, Sekula RF Jr. (eds.) Microvascular Decompression Surgery. New York City: Springer; 2016
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Goto, Y., Inoue, T. Common trunk anomaly of the anterior and posterior inferior cerebellar artery in hemifacial spasm. Acta Neurochir 164, 2945–2951 (2022). https://doi.org/10.1007/s00701-022-05230-w
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DOI: https://doi.org/10.1007/s00701-022-05230-w