The Neurosurgery Center
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Trigeminal Neuralgia
Rare Trigeminal Neuralgia Conditions
Hemifacial Spasm
Glossopharyngeal Neuralgia
Brain Tumor
Cerebral Aneurysm/Cerebral Arteriovenous Malformation
Endovascular Therapy
Gamma Knife Surgery
Spinal/Spinal Cord Disease
Parkinson’s Disease/Essential Tremor Surgery
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Inpatient Guide
Inpatient Guide


Hemifacial Spasm

We provide surgical treatment for hemifacial spasm.
Hemifacial spasm is caused by vascular compression on the most sensitive part of the facial nerve (REZ).
Microvascular decompression moves the artery away from the REZ, which leads to stabilize facial spasm.
Same as trigeminal neuralgia, 3D preoperative imaging is very useful for hemifacial spasm as well.
It is crucial that a surgeon should understand the anatomical relation between the facial nerve and adjacent cranial nerves and arteries.

¡Microvascular Decompression for Hemifacial Spasm
  • Precise preoperative imaging.
  • Key hole surgery through a small skin incision.
  • Transposition technique applied rather than interposition, which contributes to lower recurrence rate.
  • No suture on the skin, which enables to early discharge from the hospital.
  • Hospital stay is normally less than 4 days.

3D image for Hemifacial Spasm
Facial nerve (blue) runs inside of Auditory nerve (yellow).
An artery has a contact with the facial nerve REZ.
Hemifacial Spasm
Operative view
Tortuous artery contacts facial nerve on its REZ.
Operative view of Hemifacial Spasm Larger artery (Vertebral artery) can be a cause of hemifacial spasm
Tortuous artery runs on the REZ Teflon felt is used for transposition of the artery.
¡Teflon mass removal: Re-do operation

This patient had prior MVD with interposition technique.
HFS persisted due to too much Teflon inserted between the nerve and the compressing artery (microvascular recompression).
After removal of the excess of Teflon felt and appropriate transposition of the artery with sling technique, her symptoms were cured immediately after surgery.

Too much Teflon is compressing the facial nerve.

Teflon was removed and the compressing artery is exposed.

The artery is now transposed with the sling technique.
The REZ of facial nerve is free from any kind of compression.
Takuro INOUE M.D., Ph.D.
Chief Director, Neurosurgery, Kotoh Memorial Hospital

2015 Chief Director, visiting consultant Andalusia Hospital, Egypt Takuro INOUE
to present
Chief Director, Kotoh Memorial Hospital, Shiga, Japan
2007 Clinical training at Duke University, USA
2004 Gamma Knife training at Kalorinska University, Sweden
1998-2009 Neurosurgery, Hino Memorial Hospital, Shiga, Japan
1997-1998 University of British Columbia, Canada
1994-1996 Neurosurgery, Okamoto General Hospital, Kyoto, Japan
1992-1993 Neurosurgery, Saiseikai Noe Hospital, Osaka, Japan
1991-1992 Neurosurgery, University of Shiga Medical Science Hospital

2013 Skull Base Workshop, Chulalongkorn University, Thailand
2013 Asean Cerebrovascular Skull Base Hand On Course & Symposium, Chulalongkorn University, Thailand
2011 Advanced Skull Base Microanatomy Workshop and Hands-On Dissection Course, Florida, USA
2010 Advanced Skull Base Microanatomy Workshop and Hands-On Dissection Course, Florida, USA
2008 Cadaver Workshop on Skull Base, Aichi, Japan
2008 Cadaver Dissection Course, Kyoto, Japan
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