BACKGROUND:

Vascular complications in posterior fossa surgery, even in microvascular decompression (MVD) involving a small cranial opening, can have catastrophic consequences. This study analyzes these complications in order to determine the incidence, risk factors, prognosis, and preventive measures involved.

METHODS:

Between April 1997 and March 2018, 4,000 consecutive patients with neurovascular compression syndromes were admitted and MVD was performed on them. The medical records of those patients who developed vascular complications after MVD were reviewed, focusing on their past medical history, perioperative laboratory findings and images, surgical findings, and postoperative progress.

RESULTS:

Vascular complications developed in 28 (0.7%) patients; 24 of them had hemifacial spasm and four had trigeminal neuralgia. Of these, 22 (78.6%) hemorrhagic and six (21.4%) ischemic complications occurred, with epidural hematoma being the most frequently identified. Ten (35.7%) patients were asymptomatic, while 18 (64.3%) were symptomatic, and six (21.4%) underwent revision operations such as hematoma removal, craniectomy, or extraventricular drainage insertion. At the last follow-up, dizziness was the most commonly reported sequela from vascular complications, and no mortality among the patients was observed.

CONCLUSIONS:

Vascular complications are rare yet can be the most devastating adverse outcome of MVD surgery. Unusual signs and symptoms from patients after MVD should receive special attention for early management and safety of the patient.

Copyright © 2019. Published by Elsevier Inc.