고령의 반측성 안면경련증 환자군에 대한 후두골하 접근법을 이용한 미세혈관 감압술시 수술적 고려 사항

The surgical considerations of microvascular decompression via suboccipital approach for hemifacial spasm in old aged patients

Objectives : It has been reported that the outcomes of microvascular decompression (MVD) for hemifacial spasm (HFS) is satisfactory. We would like to give an account on the treatment results in patients older than 65. Methods : From July, 2001 to December, 2007, 589 HFS patients have had MVD via suboccipital approach at our hospital. Among those, 56 patients were older than 65 and were able to be followed up for more than 1 year. We examined their characteristics, treatment results and complications. Also, we analyzed the characteristics of MVD for the elderly patients considering anatomical differences of them. Results : Among the 56 patients, hypertension, diabetes mellitus, ischemic heart disease were present in 27, 3 and 3 respectively and were medicated accordingly. After MVD, 44 had immediate disappearance of HFS and 54 within 1 year after the surgery. Complication occurred in 4 cases. Two of them had epidural hematoma, but did not need surgical treatment. The anatomical characteristics of the patients who developed epidural hematoma were prominent cistern magna and cortical atrophy giving rise to relatively wider arachnoid space. Conclusion : MVD was relatively satisfactory in older HFS patients. However, their accompanied medical and anatomical vulnerability should be considered before deciding the surgical intervention and preoperative thorough examination of the radiological studies are needed to better understand anatomical characteristics rendering prone to hazardous conditions.