Para-condylar foraminal approach in microvascular decompression for hemifacial spasm

초록

The ideal appraoch in MVD for HFS should provide the shortest and the perpendicular route to the facial nerve exit zone(FNEZ) with minimal cerebellar retraction to avoid surgical morbidity. Small basal craniectomy near the condylar foramen provides the shortest surgical route, minimal cerebellar retraction, and easy exposure of FNEZ without manipulation of cisternal portion of facial nerve and cochlear nerve, because condylar foramen is located near the sigmoidojugular junction and FNEZ. We performed this approach in 10 HFS patients. Skin incision was placed from inferior nuchal line toward condylar foramen in 5 cm in length, and neck muscles were split. Condylar vein was elevated from condylar fossa. Small craniectomy extending to the upper portion of condylar foramen was made. Dura was incised in T-shape. With minimal superior elevation of flocculus after arachnoid dissection around low cranial nerves, FNEZ and offender could be identified easily. In conculusion, paracondylar foraminal approach might be minimally invasive and maximally safe in MVD for HFS