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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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Miyazaki Y, Matsubara S, Ishihara M, Minami YO, Kinoshita K, Takai H, Hirai S, Hara K, Yagi K, Uno M. Improvement of Hemifacial Spasm after Stent-assisted Coil Embolization for Ipsilateral Vertebral Artery Dissecting Aneurysm. NMC Case Rep J 2021; 8:143-150. [PMID: 35079456 PMCID: PMC8769391 DOI: 10.2176/nmccrj.cr.2020-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/06/2020] [Indexed: 11/20/2022] Open
Abstract
Microvascular decompression (MVD) is the gold standard in the treatment of hemifacial spasm (HFS), and endovascular surgery has been described as a treatment only for aneurysm-induced HFS in several previous cases. We describe symptomatic HFS caused by a normal vertebral artery (VA) trunk adjacent to the ipsilateral dissecting VA aneurysm completely cured after stent-assisted coil embolization. A 52-year-old man presented with a 2-month history of gradually worsening left HFS. Magnetic resonance imaging (MRI) and cerebral angiography revealed a dissecting VA aneurysm on the left side. Based on the findings from preoperative MRI, not the aneurysmal dome itself, but the VA trunk just distal to the aneurysmal dome was considered likely to be compressing the root exit zone (REZ) of the facial nerve. Stent-assisted coil embolization was conducted for the VA aneurysm, and the stent was deployed to cover the wide neck of the aneurysm and offending zone of the VA trunk simultaneously. HFS started to show improvement just after the procedure and complete disappearance within 1 year. HFS was completely resolved by stenting of the offending artery. Stents may show efficacy for "intra-arterial decompression" by reducing pulsatility against the REZ of the facial nerve due to the thickness and rigidity of the stent metal and delayed endothelialization.
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Affiliation(s)
- Yuko Miyazaki
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Shunji Matsubara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Manabu Ishihara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yukari Ogawa Minami
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Keita Kinoshita
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hiroki Takai
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Satoshi Hirai
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Keijirou Hara
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Ko HC, Lee SH, Shin HS, Koh JS. Treatment for Hemifacial Spasm Associated with a Dissecting Vertebral Artery Aneurysm Requiring Microvascular Decompression in Addition to Endovascular Trapping: A Case Report with Literature Review. J Neurol Surg A Cent Eur Neurosurg 2021; 83:377-382. [PMID: 33690877 DOI: 10.1055/s-0040-1721681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The treatment protocol for hemifacial spasm (HFS) associated with dissecting vertebral artery aneurysm (DVAA) has not been established. CASE DESCRIPTION A-42-year-old man with left HFS underwent endovascular trapping for a DVAA that was identified on brain imaging. Although the dissecting segment was treated successfully, the HFS persisted for 3 months, and subsequently microvascular decompression (MVD) was needed. The posteroinferior cerebellar artery (PICA) was found to be interposed between the root exit zone of the facial nerve and DVAA during surgery. After pulling out the PICA, the HFS ceased immediately. CONCLUSION HFS associated with DVAA should be considered carefully before formulating a treatment strategy. Moreover, the cause of pulsatile compression may not be visible on brain imaging, and MVD surgery may be indicated in such cases.
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Affiliation(s)
- Hak-Cheol Ko
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seung Hwan Lee
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Hee Sup Shin
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jun Seok Koh
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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Iida Y, Mori K, Kawahara Y, Fukui I, Abe K, Takeda M, Nakano T, Taguchi H, Nomura M. Hemifacial spasm caused by vertebral artery aneurysm treated by endovascular coil embolization. Surg Neurol Int 2020; 11:431. [PMID: 33365193 PMCID: PMC7749930 DOI: 10.25259/sni_564_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/18/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hemifacial spasm (HFS) caused by vertebral artery (VA) aneurysms is rare. Several cases of HFS caused by VA aneurysms treated by endovascular parent artery occlusion (PAO) have been reported. Recently, we treated a rare case of HFS caused by a saccular VA aneurysm at the bifurcation of the posterior inferior cerebellar artery (PICA), which was successfully treated by endovascular coil embolization, preserving the parent artery, and PICA. We discuss endovascular treatment for HFS induced by VA aneurysms with a literature review. CASE DESCRIPTION A 59-year-old man presented with the left HFS persisting for 2 months. Magnetic resonance imaging revealed a left saccular VA-PICA aneurysm and demonstrated that a left facial nerve was compressed by the aneurysm at the root exit zone. Angiography revealed that the PICA was branching from the aneurysm neck. Endovascular coil embolization was performed using the balloon remodeling technique to preserve the left VA and PICA. HFS disappeared after treatment. CONCLUSION Although microvascular decompression was commonly accepted for the standard treatment of HFS, coil embolization of aneurysms without PAO may be an effective treatment for HFS caused by VA aneurysms.
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Affiliation(s)
- Yu Iida
- Department of Neurosurgery Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Kentaro Mori
- Department of Neurosurgery Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Yosuke Kawahara
- Department of Neurosurgery Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Issei Fukui
- Department of Neurosurgery Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Katsuya Abe
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Mutsuki Takeda
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Tastu Nakano
- Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
| | - Hiroki Taguchi
- Department of Neurosurgery, Taguchi Neurosurgery Clinic, Yokohama, Kanagawa, Japan
| | - Motohiro Nomura
- Department of Neurosurgery Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan
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Arisawa K, Ochi T, Goto Y, Nanbu S, Shojima M, Maeda K. Coil Embolization of VA-PICA Aneurysm Presenting with Hemifacial Spasm with Assistance of Abnormal Muscle Response Monitoring. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:146-150. [PMID: 37520172 PMCID: PMC10374369 DOI: 10.5797/jnet.cr.2019-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/06/2020] [Indexed: 08/01/2023]
Abstract
Objective We report a rare case of symptomatic vertebral and posterior inferior cerebellar arteries (VA-PICA) aneurysm-caused ipsilateral hemifacial spasm (HFS) for which coil embolization of the aneurysm with the assistance of abnormal muscle response (AMR) monitoring was effective. Case Presentation A 62-year-old woman presented with left HFS. Magnetic resonance imaging showed a saccular aneurysm of the left VA-PICA which compressed the seventh cranial nerve at its root exit zone (REZ). Stent-assisted coil embolization resulted in intraoperative disappearance of AMR in the intraoperative electrophysiological study and HFS was relieved temporally. One month after endovascular surgery, HFS slightly occurred again with the re-appearance of the AMR, although there was no recurrence of aneurysm. Thereafter, the frequency of her HFS markedly decreased to once per several days 1 year after the coiling. Conclusion Although complete disappearance of symptoms was not obtained, it was suggested that coil embolization is one of the therapeutic options for HFS which is caused by aneurysmal compression of REZ and intraoperative AMR is useful for identification of responsible lesions and determination of therapeutic effects.
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Affiliation(s)
- Kei Arisawa
- Department of Neurosurgery, Aidu Chuo Hospital, Aizuwakamatsu, Fukushima, Japan
| | - Takashi Ochi
- Department of Neurosurgery, Aidu Chuo Hospital, Aizuwakamatsu, Fukushima, Japan
| | - Yoshiaki Goto
- Department of Neurosurgery, Aidu Chuo Hospital, Aizuwakamatsu, Fukushima, Japan
| | - Syohei Nanbu
- Department of Neurosurgery, Aidu Chuo Hospital, Aizuwakamatsu, Fukushima, Japan
| | - Masaaki Shojima
- Department of Neurosurgery, Saitama Medical Center/University, Kawagoe, Saitama, Japan
| | - Keiichiro Maeda
- Department of Neurosurgery, Aidu Chuo Hospital, Aizuwakamatsu, Fukushima, Japan
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Santiago-Dieppa DR, McDonald MA, Brandel MG, Rennert RC, Khalessi AA, Olson SE. Endovascular Flow Diversion for Hemifacial Spasm Induced by a Vertebral Artery Aneurysm: First Experience. Oper Neurosurg (Hagerstown) 2018; 17:E115-E118. [DOI: 10.1093/ons/opy359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/18/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Flow diversion for the treatment of aneurysm-induced hemifacial spasm (HFS) has not been previously described.
CLINICAL PRESENTATION
The authors present the case of a 60-yr-old woman who presented with 1 yr of progressive left HFS secondary to a vertebral artery aneurysm compressing the root entry zone of cranial nerve VII. The patient's aneurysm was successfully treated with a flow diverting stent.
CONCLUSION
In the immediate postoperative period, the patient had near complete resolution of her HFS symptoms. At her 6-mo follow-up the patient had no angiographic filling of the aneurysm and her HFS symptoms had completely resolved.
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Affiliation(s)
| | - Marin A McDonald
- Department of Radiology, University of California-San Diego, La Jolla, California
| | - Michael G Brandel
- Department of Neurosurgery, University of California-San Diego, La Jolla, California
| | - Robert C Rennert
- Department of Neurosurgery, University of California-San Diego, La Jolla, California
| | - Alexander A Khalessi
- Department of Neurosurgery, University of California-San Diego, La Jolla, California
| | - Scott E Olson
- Department of Neurosurgery, University of California-San Diego, La Jolla, California
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Fluid structure interaction analysis reveals facial nerve palsy caused by vertebral-posterior inferior cerebellar artery aneurysm. Comput Biol Med 2015; 66:263-8. [DOI: 10.1016/j.compbiomed.2015.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 09/18/2015] [Accepted: 09/19/2015] [Indexed: 10/23/2022]
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Li C, Li Y, Jiang C, Wu Z, Wang Y, Yang X. Remission of neurovascular conflicts in the cerebellopontine angle in interventional neuroradiology. J Neurointerv Surg 2014; 8:87-93. [DOI: 10.1136/neurintsurg-2014-011500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/09/2014] [Indexed: 11/03/2022]
Abstract
Background and purposeTo investigate the efficacy of endovascular treatment (EVT) for neurovascular conflicts (NVCs) in the cerebellopontine angle (CPA) caused by intracranial aneurysms (IAs) and intracranial arteriovenous malformations (AVMs), including trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia.Materials and methodsFrom January 2010 to January 2014, 14 consecutive patients presenting with three NVCs caused by IAs or intracranial AVMs were admitted to our department. The clinical outcomes of these NVCs after EVT were retrospectively analyzed.ResultsFor four patients with IAs, angiographic follow-up confirmed total occlusion of the lesion in all, and the clinical outcomes of NVC were as follows: gradual relief in two (50%), transient partial relief but recurrence in one (25%), and no palliative effect in one (25%). For the 10 patients with intracranial AVMs, one (10%) experienced transient relief of NVC after angiogram examination (no EVT was performed). Of the other nine patients who received EVT, angiographic follow-up was obtained in seven (70%), demonstrating total obliteration of the lesion in three (30%), subtotal obliteration in two (20%), and partial obliteration in two (20%). Clinical outcomes included immediate relief of NVCs after single EVT in two cases (20%), gradual relief after single EVT in five (50%, one of them experienced transient aggravation), and complete relief after two sessions of EVT in two (20%). Complications of transient cranial nerve paresis related to EVT occurred in two cases (20%) with intracranial AVMs. In all, complete lasting relief of the NVCs was obtained finally in 11 cases (78.6%).ConclusionsEVT is a feasible and less invasive approach for relief of NVCs in the CPA caused by IA or intracranial AVM and could be considered as a therapeutic option in these situations.
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The value of abnormal muscle response monitoring during microvascular decompression surgery for hemifacial spasm. Int J Surg 2011; 9:347-51. [DOI: 10.1016/j.ijsu.2011.02.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 02/15/2011] [Accepted: 02/18/2011] [Indexed: 11/22/2022]
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Tormenti MJ, Lin R, Jankowitz BT, Horowitz MB. PICA origin aneurysm diagnosed 27 years after microvascular decompression of cranial nerve VII. J Neuroimaging 2009; 21:83-6. [PMID: 19555405 DOI: 10.1111/j.1552-6569.2009.00396.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The authors report a case of a posterior inferior cerebellar artery origin aneurysm causing brainstem compression and swallowing difficulty. The patient had an ipsilateral microvascular decompression of cranial nerve VII for hemifacial spasm 27 years prior to the discovery of the aneurysm. The aneurysm was successfully treated endovascularly. A discussion of possible etiologies of the aneurysm's formation is presented.
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Affiliation(s)
- Matthew J Tormenti
- Departments of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Choi SK, Rhee BA, Park BJ, Lim YJ. Hemifacial spasm caused by fusiform aneurysm at vertebral artery-posterior inferior cerebellar artery junction. J Korean Neurosurg Soc 2008; 44:399-400. [PMID: 19137088 DOI: 10.3340/jkns.2008.44.6.399] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 11/24/2008] [Indexed: 11/27/2022] Open
Abstract
Hemifacial spasm induced by intracranial aneurysm is a rare clinical condition. A 45-year-old male patient presented with a 3-year history of progressive involuntary twitching movement on right face. On radiological study, a dilated vascular lesion compressing the brain stem was found at the junction of vertebral artery and posterior inferior cerebellar artery. On operative field, we found the posterior inferior cerebellar artery and the fusiform aneurysm compressing root exit zone of facial nerve. Microvascular decompression was performed and the facial symptom was relieved without complications.
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Affiliation(s)
- Seok-Keun Choi
- Department of Neurosurgery, School of Medicine, Kyung-Hee University, Seoul, Korea
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Deshmukh VR, Maughan PH, Spetzler RF. Resolution of Hemifacial Spasm after Surgical Obliteration of a Tentorial Arteriovenous Fistula: Case Report. Neurosurgery 2006; 58:E202; discussion E202. [PMID: 16385320 DOI: 10.1227/01.neu.0000192386.89105.82] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
We describe a patient with a tentorial dural arteriovenous fistula who presented with ipsilateral hemifacial spasm.
CLINICAL PRESENTATION:
A 50-year-old man sought treatment for left facial twitching that worsened over 6 months. Magnetic resonance imaging and catheter angiography demonstrated a left tentorial dural arteriovenous fistula.
INTERVENTION:
The patient underwent a retrosigmoid craniotomy and ligation of the draining vein at the site of the fistula. Intraoperative angiography showed complete obliteration of the fistula. The patient's hemifacial spasm improved significantly after the fistula was obliterated.
CONCLUSION:
Posterior fossa arteriovenous fistulas can present with a hemifacial spasm related to compression of the facial nerve by arterialized leptomeningeal veins. Microsurgical obliteration of the fistula can resolve the related symptoms.
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Affiliation(s)
- Vivek R Deshmukh
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Wilkinson MF, Kaufmann AM. Monitoring of facial muscle motor evoked potentials during microvascular decompression for hemifacial spasm: evidence of changes in motor neuron excitability. J Neurosurg 2005; 103:64-9. [PMID: 16121975 DOI: 10.3171/jns.2005.103.1.0064] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Hemifacial spasm (HFS) is thought to be due to a hyperactive facial motor nucleus consequent to chronic neurovascular contact. The lateral spread (LS) response is presumed to reflect changes in facial motor neuron excitability. Facial muscle motor evoked potentials (MEPs) use the same efferent pathway as LS, therefore the authors speculated that these potentials should reflect differences consistent with changes at the facial motor nucleus level. METHODS Monitoring of LS and bilateral facial MEP was performed in 10 consecutive patients undergoing MVD for HFS. Ipsilateral facial MEPs were monitored in 17 patients undergoing MVD for trigeminal neuralgia (TN). Latency, amplitude, and duration of the MEPs were compared before and after MVD. Following MVD the duration of ipsilateral MEPs decreased from 17.6 +/- 1.2 to 7.6 +/- 0.7 msec and their amplitude decreased from 269.9 +/- 66.3 to 76.5 +/- 26.2 microV (p < or = 0.01). These changes were consequent to the abolition of LS in eight of 10 patients and an approximately 50% reduction in two patients. The relationship between the reduction in MEPs and changes in LS was significant (p < 0.01). Control facial muscle MEPs (nonspastic side in patients with HFS and in those with TN) did not change significantly during the MVD procedure. Spasms were alleviated in nine of 10 patients, and there was no indication of facial nerve damage intraoperatively or postoperatively. CONCLUSIONS Facial muscle MEPs represent a novel tool for studying the neurophysiological mechanisms of HFS in particular and monitoring the facial nerve in general. Data in this study support the hypothesis that the development of HFS and its alleviation with MVD are related to changes in facial motor nucleus activity.
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Affiliation(s)
- Marshall F Wilkinson
- Centre for Cranial Nerve Disorders, Division of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada.
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