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Li B, Huang L, Luo C, Jin Y, Zhong X, Wang G, Xu Z, Chen J, Huang S, Zhao H, Gao M. Radiological characteristics predicting early poor drug response in patients with hemifacial spasm. Neurol Sci 2024; 45:3217-3224. [PMID: 38347297 DOI: 10.1007/s10072-024-07389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/04/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Patients with hemifacial spasm (HFS) often resort to botulinum toxin injections or microvascular decompression surgery when medication exhibits limited effectiveness. This study aimed to identify MRI and demographic factors associated with poor drug response at an early stage in patients with HFS. METHODS We retrospectively included patients with HFS who underwent pre-therapeutic MRI examination. The presence, location, severity, and the offending vessels of neurovascular compression were blindly evaluated using MRI. Drug responses and clinical data were obtained from the medical notes or phone follow-ups. Logistic regression analysis was performed to identify potential factors. RESULTS A total of 116 patients were included, with an average age at the time of first examination of 50.4 years and a median duration of onset of 18 months. Forty-nine (42.2%) patients reported no symptom relief. Thirty-seven (31.9%) patients reported poor symptom relief. Twenty-two (19.0%) patients reported partial symptom relief. Eight (6.9%) patients achieved complete symptom relief. The factors that were statistically significant associated with poor drug responses were contact in the attach segment of the facial nerve and aged 70 and above, with an odds ratio of 7.772 (p = 0.002) and 0.160 (p = 0.028), respectively. CONCLUSIONS This study revealed that mild compression in the attach segment of the facial nerve in pre-therapeutic MRI increases the risk of poor drug responses in patients with HFS, while patients aged 70 and above showed a decreased risk. These findings may assist clinician to choose optimal treatment at an early stage.
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Affiliation(s)
- Bo Li
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
- Sun Yat-Sen University, Guangzhou, 510080, Guangdong Province, China
| | - Linwen Huang
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Chun Luo
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Yabin Jin
- Institute of Translational Medicine, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Xuguang Zhong
- Department of Functional Neurosurgery, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Guofu Wang
- Department of Functional Neurosurgery, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Zhifeng Xu
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Jingxian Chen
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Shengqiao Huang
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China
| | - Hai Zhao
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China.
| | - Mingyong Gao
- Department of Radiology, The First People's Hospital of Foshan, Foshan, 528000, Guangdong Province, China.
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Shen L, Yang J, Cheng R, Yue C, Wang T, Chai S, Cai Y, Zhou Y, Xu D, Lei Y, Wang M, Mei Z, Zhao J, Dai X, Yang B, Chen J, Yu Y, Xiong N. Bridge-layered decompression technique for vertebral artery-involved hemifacial spasm: technical note. BMC Surg 2024; 24:154. [PMID: 38745320 PMCID: PMC11092177 DOI: 10.1186/s12893-024-02415-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Hemifacial spasm (HFS) is most effectively treated with microvascular decompression (MVD). However, there are certain challenges in performing MVD for HFS when the vertebral artery (VA) is involved in compressing the facial nerve (VA-involved). This study aimed to introduce a "bridge-layered" decompression technique for treating patients with VA-involved HFS and to evaluate its efficacy and safety to treat patients with HFS. METHODS A single-center retrospective analysis was conducted on the clinical data of 62 patients with VA-involved HFS. The tortuous trunk of VA was lifted by a multi-point "bridge" decompression technique to avoid excessive traction of the cerebellum and reduce the risk of damage to the facial-acoustic nerve complex. To fully decompress all the responsible vessels, the branch vessels of VA were then isolated using the "layered" decompression technique. RESULTS Among the 62 patients, 59 patients were cured immediately after the surgery, two patients were delayed cured after two months, and one had occasional facial muscle twitching after the surgery. Patients were followed up for an average of 19.5 months. The long-term follow-up results showed that all patients had no recurrence of HFS during the follow-up period, and no patients developed hearing loss, facial paralysis, or other permanent neurological damage complications. Only two patients developed tinnitus after the surgery. CONCLUSION The "bridge-layered" decompression technique could effectively treat VA-involved HFS with satisfactory safety and a low risk of hearing loss. The technique could be used as a reference for decompression surgery for VA-involved HFS.
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Affiliation(s)
- Lei Shen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Jingyi Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Runqi Cheng
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Chuqiao Yue
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Tiansheng Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Songshan Chai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Yuankun Cai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Yixuan Zhou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Dongyuan Xu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Yu Lei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Mengyang Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Zhimin Mei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Jingwei Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Xuan Dai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Bangkun Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China
| | - Yanbing Yu
- Department of Neurosurgery, Sino-Japanese Friendship Hospital, Beijing, 100029, China.
| | - Nanxiang Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, Hubei, China.
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Lv K, Zhang C, Liu B, Yang A, Luan J, Hu P, Yao Z, Liu J, Ma G. White matter structural changes before and after microvascular decompression for hemifacial spasm. Brain Struct Funct 2024; 229:959-970. [PMID: 38502329 DOI: 10.1007/s00429-023-02741-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/22/2023] [Indexed: 03/21/2024]
Abstract
Hemifacial spasm (HFS) is a syndrome characterized by involuntary contractions of the facial muscles innervated by the ipsilateral facial nerve. Currently, microvascular decompression (MVD) is an effective treatment for HFS. Diffusion weighted imaging (DWI) is a non-invasive advanced magnetic resonance technique that allows us to reconstruct white matter (WM) virtually based on water diffusion direction. This enables us to model the human brain as a complex network using graph theory. In our study, we recruited 32 patients with HFS and 32 healthy controls to analyze and compare the topological organization of whole-brain white matter networks between the groups. We also explored the potential relationships between altered topological properties and clinical outcomes. Compared to the HC group, the white matter network was disrupted in both preoperative and postoperative groups of HFS patients, mainly located in the somatomotor network, limbic network, and default network (All P < 0.05, FDR corrected). There was no significant difference between the preoperative and postoperative groups (P > 0.05, FDR corrected). There was a correlation between the altered topological properties and clinical outcomes in the postoperative group of patients (All P < 0.05, FDR corrected). Our findings indicate that in HFS, the white matter structural network was disrupted before and after MVD, and that these alterations in the postoperative group were correlated with the clinical outcomes. White matter alteration here described may subserve as potential biomarkers for HFS and may help us identify patients with HFS who can benefit from MVD and thus can help us make a proper surgical patient selection.
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Affiliation(s)
- Kuan Lv
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Chuanpeng Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Neurosurgery, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Bing Liu
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Aocai Yang
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jixin Luan
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pianpian Hu
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Zeshan Yao
- Jingjinji National Center of Technology Innovation, Beijing, China
| | - Jiang Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China.
| | - Guolin Ma
- Department of Radiology, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing, 100029, China.
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
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Xu F, Gu P, Yuan H, Jiang L, Xie Y, Shi Q, Zhan Y. Analysis of risk factors related to the progression rate of hemifacial spasm. Front Neurol 2024; 15:1357280. [PMID: 38606273 PMCID: PMC11007217 DOI: 10.3389/fneur.2024.1357280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Although there have been many researches on the etiology and risk factors with the onset of hemifacial spasm, researches on the risk factors related to progression rate are limited. This study aims to analyze the risk factors related to the progression rate of hemifacial spasm. Methods The study enrolled 142 patients who underwent microvascular decompression for hemifacial spasm. Based on the duration and severity of symptoms, patients were classified into rapid progression group and slow progression group. To analyze risk factors, univariate and multivariate logistic regression analyses were conducted. Of 142 patients with hemifacial spasm, 90(63.3%) were classified as rapid progression group, 52(36.7%) were classified as slow progression group. Results In the univariate analysis, there were significant statistical differences between the two groups in terms of age of onset (P = 0.021), facial nerve angle (P < 0.01), hypertension (P = 0.01), presence of APOE ε4 expression (P < 0.01) and different degrees of brainstem compression in the Root Entry Zone (P < 0.01). In the multivariable analyses, there were significant statistical differences between the two groups in terms of age of symptom onset (P < 0.01 OR = 6.591), APOE ε4 (P < 0.01 OR = 5.691), brainstem compression (P = 0.006 OR = 5.620), and facial nerve angle (P < 0.01 OR = 5.758). Furthermore, we found no significant correlation between the severity of facial spasms and the progression rate of the disease (t = 2.47, P = 0.12>0.05). Conclusion According to our study, patients with facial nerve angle ≤ 96.5°, severer compression of the brainstem by offending vessels, an onset age > 45 years and positive expression of APOE ε4, may experience faster progression of hemifacial spasm.
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Li B, Luo C, Jin Y, Yi Y, Cheng D, Huang L, Wang G, Zhong X, Zhao H, Gao M. Evaluating magnetic resonance imaging characteristics and risk factors for hemifacial spasm. Brain Behav 2024; 14:e3438. [PMID: 38409893 PMCID: PMC10897361 DOI: 10.1002/brb3.3438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE The specific neurovascular compression (NVC) event responsible for the symptomatic manifestation of hemifacial spasm (HFS) remains difficult to assess accurately using magnetic resonance imaging (MRI). We aim to evaluate the MRI characteristics of HFS. METHOD We retrospectively included patients with HFS and divided them into a test group (n = 186) and a validation group (n = 28). The presence, severity, and offending vessel type of NVC in each portion, and the orientation of the offending vessel around the facial nerve, were recorded. Conditional logistic regression analyses were performed to evaluate correlations using test group. The validation group was used to verify whether our findings improved diagnostic performance. RESULTS Deformity in the proximal cisternal segment was significantly correlated with HFS occurrence (odds ratio [OR]: 256.58, p = .002), whereas contact was not (p = .233). Both contact and deformity in the root detachment point (OR: 19.98 and 37.22, p < .001 and p = .013, respectively) or attached segment (OR: 4.99 and 252.52, p = .001 and p < .001, respectively) were significantly correlated with HFS occurrence. Our findings improved specificity, positive predictive value, and accuracy of diagnosis than conventional diagnostic methods. The vertebral artery predominantly compress the facial nerve in the inferior-anterior position, the anterior inferior cerebellar artery predominantly in the inferior position, the posterior inferior cerebellar artery predominantly in the inferior position, vein predominantly in the posterior-superior position. CONCLUSIONS This study further demonstrates that within the susceptible portion of facial nerve, different portions of the nerve respond differently to NVC. Each offending vessel has its own preferred conflict orientation. Our study offers reference for neurosurgeons in diagnosis and treatment.
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Affiliation(s)
- Bo Li
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
- Sun Yat‐Sen UniversityGuangzhouGuangdong ProvinceChina
| | - Chun Luo
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Yabin Jin
- Institute of Translational MedicineThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Ying Yi
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Dongliang Cheng
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Linwen Huang
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Guofu Wang
- Department of Functional NeurosurgeryThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Xuguang Zhong
- Department of Functional NeurosurgeryThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Hai Zhao
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
| | - Mingyong Gao
- Department of RadiologyThe First People's Hospital of FoshanFoshanGuangdong ProvinceChina
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Chen YY, Chuang MT, Tai SH, Lee EJ. Choroid plexus papilloma at the root entry zone causing hemifacial spasm. Kaohsiung J Med Sci 2023; 39:1157-1158. [PMID: 37615271 DOI: 10.1002/kjm2.12747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Yi-Yun Chen
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Tsung Chuang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Huang Tai
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - E-Jian Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
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Jeon C, Kim M, Lee HS, Kong DS, Park K. Outcomes after Microvascular Decompression for Hemifacial Spasm without Definite Radiological Neurovascular Compression at the Root Exit Zone. Life (Basel) 2023; 13:2064. [PMID: 37895445 PMCID: PMC10608077 DOI: 10.3390/life13102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
The purpose of this study was to investigate the outcome of microvascular decompression (MVD) in patients with hemifacial spasm (HFS) who have no definite radiological neurovascular compression (NVC). Sixteen HFS patients without radiological NVC on preoperative MRI underwent MVD surgery. The symptoms were left-sided in fourteen (87.5%) and right-sided in two patients (12.5%). Intraoperatively, the most common vessel compressing the facial nerve was the AICA (8, 44.4%), followed by arterioles (5, 27.8%), veins (4, 22.2%), and the PICA (1, 5.6%). The most common compression site was the cisternal portion (13, 76.5%) of the facial nerve, followed by the REZ (4, 23.5%). One patient (6.3%) was found to have multiple NVC sites. Arachnoid type (7, 50%) was the most common compressive pattern, followed by perforator type (4, 28.6%), sandwich type (2, 14.3%), and loop type (1, 7.1%). A pure venous compression was seen in two patients, while a combined venous-arterial "sandwich" compression was detected in two patients. Symptom improvement was observed in all of the patients. Only one patient experienced recurrence after improvement. Based on our experience, MVD surgery can be effective for primary HFS patients with no definite radiological NVC. MVD can be considered if the patient shows typical HFS features, although NVC is not evident on MRI.
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Affiliation(s)
- Chiman Jeon
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan 15355, Republic of Korea;
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Republic of Korea;
| | - Hyun-Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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He P, Li Z, Jiang H. Hemifacial spasm caused by unruptured fusiform vertebral aneurysm treated with endovascular coil embolization: a case report. Front Neurol 2023; 14:1203751. [PMID: 37560448 PMCID: PMC10407084 DOI: 10.3389/fneur.2023.1203751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/04/2023] [Indexed: 08/11/2023] Open
Abstract
Hemifacial spasm due to fusiform aneurysm of the vertebral artery is extremely rare. The lateral spread response (LSR) is routinely used to monitor hemifacial spasms during microvascular decompression to predict the degree of postoperative remission of hemifacial spasm. We report a case of hemifacial spasm caused by an unruptured fusiform vertebral aneurysm treated with intravascular intervention and monitoring of LSR. A 59-year-old man was admitted to the hospital with a left facial spasm that gradually worsened for 1 year. Preoperative cerebrovascular angiography indicated fusiform aneurysms in the intracranial segment of the left vertebral artery close to the left facial nerve. The patient underwent parent artery occlusion and aneurysm embolization, and LSR was monitored intraoperatively. After intraoperative aneurysm embolization, LSR disappeared immediately. The postoperative review of cerebrovascular angiography indicated that the parent artery and aneurysm were embolized successfully, and the patient's left facial spasm was relieved after surgery. Hemifacial spasm caused by the vertebral artery fusiform aneurysm can be safely and effectively treated by parent artery occlusion and aneurysm embolization. Meanwhile, intraoperative LSR monitoring can be used to predict postoperative efficacy.
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Affiliation(s)
- Pengchen He
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Zongping Li
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Han Jiang
- Department of Rehabilitation Therapy, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
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Vieira AR, Sekula RF, Deeley K. Classical trigeminal neuralgia is associated with gephyrin and sodium voltage-gated channel alpha subunit 8. FRONTIERS IN DENTAL MEDICINE 2023. [DOI: 10.3389/fdmed.2022.988094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Trigeminal neuralgia is highly debilitating, and its etiology is still undefined. The goal of this work was to define associations between well-characterized trigeminal neuralgia cases and common genetic variants in the population. two hundred and fifty-seven individuals diagnosed with classical trigeminal neuralgia were compared to 865 individuals without classical trigeminal neuralgia and with an assessment for lower or higher pain threshold based on the amount of anesthetic required for routine dental treatment. Genotypes of 24 variants marking genes in the VGSC (voltage-gated sodium channels) or GABA (gamma-aminobutyric acid) pathways were obtained using TaqMan chemistry end end-point analysis. Chi-square was used for all comparisons with an alpha of 0.002. An association between classical trigeminal neuralgia and individuals requiring less or more anesthetic for routine dental treatments showed associations with SCN8A rs1601012 and GPHN rs723432 (p = 0.0009 and p = 0.0002, respectively). In conclusion, classical trigeminal neuralgia is associated with SCN8A and GPHN and markers rs1601012 rs723432 may be useful to determine individual risks for the condition.
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Hemifacial Spasm Caused by Distal Neurovascular Compression Confirmed by Lateral Spread Response Monitoring. J Craniofac Surg 2022; 33:2555-2559. [DOI: 10.1097/scs.0000000000008820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 02/04/2023] Open
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Patel KP, Eubanks K, Wecht DA, Sekula RF. Facial Nerve Massage for the Treatment of Hemifacial Spasm Refractory to Microvascular Decompression: Outcomes and Complications. Neurosurgery 2022; 91:570-574. [PMID: 35876666 DOI: 10.1227/neu.0000000000002075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND After microvascular decompression (MVD) for hemifacial spasm (HFS), a minority of patients realize little to no relief of spasms. In some patients, the absence of relief of spasms results from incomplete or inadequate decompression of vascular compression of the facial nerve, and these patients represent excellent candidates for repeat MVD. However, in other patients, repeat MVD is not appropriate because adequate decompression and resolution of neurovascular compression, as determined by postoperative high-resolution MRI, was achieved with the initial operation. OBJECTIVE To present a cohort of patients with a history of HFS refractory to MVD, with no evidence of neurovascular compression on postoperative MRI, who underwent facial nerve massage (FNM) in the posterior fossa in an attempt to relieve spasms. METHODS Thirteen patients with a history of incomplete relief of spasms after technically adequate MVD surgery for hemifacial spasm underwent FNM. Immediate and long-term degree of spasm relief and complications after FNM were documented through in-person or telemedicine interview. RESULTS At follow-up after FNM, 7 of 12 patients (58.3%) reported complete spasm relief (grade I), 2 of 12 patients (16.7%) reported >75% spasm relief (grade II), 0 patient (0%) reported >50% spasm relief (grade III), 3 of 12 (25.0%) patients reported <50% spasm relief (grade IV), and 1 patient was lost to follow-up. One patient experienced a delayed facial paresis, and another patient experienced high-frequency hearing loss. CONCLUSION After FNM, durable and, at least, partial relief of spasms with a relatively low complication rate was observed in most patients with HFS with incomplete relief of spasms after technically adequate prior MVD.
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Affiliation(s)
- Kevin P Patel
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Komal Eubanks
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel A Wecht
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Raymond F Sekula
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Traylor KS, Branstetter BF. Cranial Nerve Anatomy. Neuroimaging Clin N Am 2022; 32:565-576. [PMID: 35843663 DOI: 10.1016/j.nic.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The 12 cranial nerves (CNs) all have important functions. All, except the accessory nerve, arise solely within the cranial vault. We will discuss each CN function along with its entire CN course. The modality of choice for evaluation of the CN itself is typically MRI, however, CT is very important to access the bony foramina and CN boundaries..
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Affiliation(s)
- Katie Suzanne Traylor
- Neuroradiology Division, University of Pittsburgh School of Medicine, 200 Lothrop Street, South Tower, 2nd Floor, Suite 200, Pittsburgh, PA 15213, USA.
| | - Barton F Branstetter
- Neuroradiology Division, University of Pittsburgh School of Medicine, 200 Lothrop Street, South Tower, 2nd Floor, Suite 200, Pittsburgh, PA 15213, USA
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Shi X, Zhang X, Xu L, Xu Z. Neurovascular Compression Syndrome:Trigeminal neuralgia, Hemifacial spasm, Vestibular paroxysmia, Glossopharyngeal neuralgia, four case reports and review of literature. Clin Neurol Neurosurg 2022; 221:107401. [DOI: 10.1016/j.clineuro.2022.107401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/02/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022]
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14
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Chan LL, Tan EK. Neurovascular compression in hemifacial spasm. Brain 2021; 144:e91. [PMID: 34528087 DOI: 10.1093/brain/awab338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ling-Ling Chan
- Diagnostic Radiology, Singapore General Hospital, 169608, Singapore.,Radiological Sciences and Neuroscience, Duke-NUS Medical School, 169857, Singapore
| | - Eng-King Tan
- Radiological Sciences and Neuroscience, Duke-NUS Medical School, 169857, Singapore.,Neurology, National Neuroscience Institute, 308433, Singapore
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15
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Traylor KS, Sekula RF, Eubanks K, Muthiah N, Chang YF, Hughes MA. Reply: Neurovascular compression in hemifacial spasm. Brain 2021; 144:awab339. [PMID: 34554199 DOI: 10.1093/brain/awab339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/05/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Katie S Traylor
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 152103, USA
| | - Raymond F Sekula
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh 15313 PA, USA
| | - Komal Eubanks
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh 15313 PA, USA
| | - Nallammai Muthiah
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh 15313 PA, USA
| | - Yue-Fang Chang
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh 15313 PA, USA
| | - Marion A Hughes
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 152103, USA
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Hughes MA, Traylor KS, Branstetter Iv BF, Eubanks KP, Chang YF, Sekula RF. Imaging predictors of successful surgical treatment of hemifacial spasm. Brain Commun 2021; 3:fcab146. [PMID: 34396106 PMCID: PMC8361424 DOI: 10.1093/braincomms/fcab146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/17/2021] [Accepted: 05/17/2021] [Indexed: 11/14/2022] Open
Abstract
Identify preoperative imaging findings in hemifacial spasm patients that predict the post-surgical success following microvascular decompression. This is a retrospective study of patients who were diagnosed with hemifacial spasm, had a dedicated cranial nerve MRI, and underwent microvascular decompression for hemifacial spasm. Bilateral facial nerves were interrogated for neurovascular compression. If neurovascular compression was identified, we recorded whether the offending vessel was an artery, a vein or both. The location of the neurovascular compression (proximal nerve versus distal nerve) was noted. The severity of the neurovascular compression was categorized as contact versus deformity of the nerve. Patients were contacted to determine their post-operative spasm status. The relationships between imaging findings and post-surgical outcome were assessed by Chi-square tests, and odds ratios were calculated to quantify the degree of association. The study included 212 patients. Upon follow up, 192 patients were spasm free (90.57%). Imaging findings on the symptomatic side were as follows: arterial neurovascular compression was seen in 207 patients (97.64%), venous only neurovascular compression in two patients (0.94%), and no neurovascular compression in three patients (1.42%). Arterial neurovascular compression along the proximal, susceptible segment of the nerve was observed in 202 patients (95.28%); deformity was observed more commonly than contact alone. Arterial neurovascular compression along the distal segment only of the nerve was observed in five patients (2.36%). In patients with arterial neurovascular compression of the proximal and distal portions of the nerve, 93.07% and 60.0% of patients were spasm-free respectively. If venous neurovascular compression only was observed on imaging, 0% of patients were spasm-free. Patients with arterial neurovascular compression of the susceptible segment are much more likely to be spasm free than patients without this imaging finding, [odds ratio 20.14 (CI 5.08, 79.81), P-value <0.0001]. When comparing the two groups of arterial neurovascular compression (deformity versus contact), no statistically significant difference in outcomes was observed. In patients with hemifacial spasm undergoing microvascular decompression, imaging findings do predict surgical outcome. Patients with arterial neurovascular compression of the proximal, susceptible portion of the nerve are much more likely to be spasm free after surgery than those without this imaging finding. The imaging findings inform the risk benefit analysis and discussion with patients before they undergo microvascular decompression for hemifacial spasm.
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Affiliation(s)
- Marion A Hughes
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.,Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Katie S Traylor
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Barton F Branstetter Iv
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.,Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Komal P Eubanks
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Yue-Fang Chang
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Raymond F Sekula
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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