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Arai S, Shimizu K, Matsumoto M, Mizutani T. Surgical treatment of hemifacial spasm caused by fusiform vertebral artery aneurysm: case report and literature review. Br J Neurosurg 2022:1-3. [PMID: 35200092 DOI: 10.1080/02688697.2022.2039375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/27/2021] [Accepted: 02/02/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Root exit zone (REZ) compression by a fusiform vertebral artery (VA) aneurysm is a rare cause of hemifacial spasm (HFS). We report a case of successful microvascular decompression (MVD) for the treatment of HFS caused by a fusiform VA aneurysm. We also review the relevant literature and demonstrate the effectiveness of surgical treatment. CASE DESCRIPTION A 64-year-old man presented with a 2-year and 4-month history of progressive involuntary facial twitching on the right side. Radiological examination revealed a fusiform right VA aneurysm. The REZ that was compressed by the aneurysm and the underlying anterior inferior cerebellar artery (AICA) was surgically decompressed by transposing the VA and AICA and wrapping the aneurysm. Immediately post-operation, the patient's symptoms disappeared. For 7 years and 4 months postoperatively, there was no symptom recurrence or increase in aneurysm size. CONCLUSION MVD is an effective treatment for HFS caused by a fusiform VA aneurysm because symptoms are likely to improve immediately after treatment.
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Affiliation(s)
- Shintaro Arai
- Department of Neurosurgery, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Katsuyoshi Shimizu
- Department of Neurosurgery, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Masaki Matsumoto
- Department of Neurosurgery, Showa University School of Medicine, Shinagawa, Tokyo, Japan
| | - Tohru Mizutani
- Department of Neurosurgery, Showa University School of Medicine, Shinagawa, Tokyo, Japan
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Tominaga K, Endo H, Sugiyama SI, Osawa SI, Niizuma K, Tominaga T. Computational hemodynamic analysis of the offending vertebral artery at the site of neurovascular contact in a case of hemifacial spasm associated with subclavian steal syndrome: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 2:CASE21447. [PMID: 35855406 PMCID: PMC9265183 DOI: 10.3171/case21447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) is caused by neurovascular contact along the facial nerve’s root exit zone (REZ). The authors report a rare HFS case that was associated with ipsilateral subclavian steal syndrome (SSS). OBSERVATIONS A 42-year-old man with right-sided aortic arch presented with progressing left HFS, which was associated with ipsilateral SSS due to severe stenosis of the left brachiocephalic trunk. Magnetic resonance imaging showed contact between the left REZ and vertebral artery (VA), which had shifted to the left. The authors speculated that the severe stenosis at the left brachiocephalic trunk resulted in the left VA’s deviation, which was the underlying cause of the HFS. The authors performed percutaneous angioplasty (PTA) to dilate the left brachiocephalic trunk. Ischemic symptoms of the left arm improved after PTA, but the HFS remained unchanged. A computational fluid dynamics study showed that the high wall shear stress (WSS) around the site of neurovascular contact decreased after PTA. In contrast, pressure at the point of neurovascular contact increased after PTA. LESSONS SSS is rarely associated with HFS. Endovascular treatment for SSS reduced WSS of the neurovascular contact but increased theoretical pressure of the neurovascular contact. Physical release of the neurovascular contact is the best treatment option for HFS.
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Affiliation(s)
| | - Hidenori Endo
- Departments of Neurosurgery and
- Neurosurgical Engineering and Translational Neuroscience and
- Division of Advanced Cerebrovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | - Kuniyasu Niizuma
- Departments of Neurosurgery and
- Department of Neuroanesthesia, Kohnan Hospital, Sendai, Japan; and
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Onuki A, Oinuma M, Fujimori D, Munakata R, Horiuchi K, Watanabe Z, Watanabe K. Hemifacial Spasm Caused by Compression of a Vertebral Artery Aneurysm Consequently Improved by Stent-assisted Coil Embolization. J Neuroendovasc Ther 2020; 14:390-393. [PMID: 37501668 PMCID: PMC10370903 DOI: 10.5797/jnet.cr.2020-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/24/2020] [Indexed: 07/29/2023]
Abstract
Objective We described a rare hemifacial spasm (HFS) caused by compression of a vertebral artery (VA) aneurysm that was consequently improved by stent-assisted coil embolization. Case Presentation A 60-year-old man presented with a chief complaint of left HFS that had persisted for 1 month. It had initially appeared in the orbicularis oculi, spread to the orbicularis oris, and severely disrupted his quality of life. Both MRI and MRA revealed a wide-necked aneurysm of the left VA (neck 8.5 mm, dome 6.0 mm) compressing the left facial nerve root exit zone (REZ). We performed stent-assisted coil embolization because the VA was dominant at this side of the aneurysm and we tried to preserve normal antegrade flow. The HFS disappeared immediately after embolization without complications. After 6 month follow-up, the patient had no recurrence of symptoms and MRA showed no recurrence of the aneurysm. Conclusion Stent-assisted coil embolization was effective for treating HFS caused by compression of a VA aneurysm and it might be the treatment of choice for this type of aneurysmal HFS.
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Affiliation(s)
- Akinori Onuki
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama, Fukushima, Japan
| | - Masahiro Oinuma
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama, Fukushima, Japan
| | - Daichi Fujimori
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama, Fukushima, Japan
| | - Ryoji Munakata
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama, Fukushima, Japan
| | - Kazuomi Horiuchi
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama, Fukushima, Japan
| | - Zenichiro Watanabe
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama, Fukushima, Japan
| | - Kazuo Watanabe
- Department of Neurosurgery, Southern TOHOKU Research Institute for Neuroscience, Southern TOHOKU General Hospital, Koriyama, Fukushima, Japan
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Wang QP, Yuan Y, Xiong NX, Fu P, Huang T, Yang B, Liu J, Chu X, Zhao HY. Anatomic Variation and Hemodynamic Evolution of Vertebrobasilar Arterial System May Contribute to the Development of Vascular Compression in Hemifacial Spasm. World Neurosurg 2018; 124:S1878-8750(18)32897-3. [PMID: 30593967 DOI: 10.1016/j.wneu.2018.12.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) is caused by vascular compression of the facial nerve. The definitive mechanism of offending vessel formation remains unclear. The aim of this study was to explore whether the anatomic and hemodynamic characteristics of the vertebrobasilar artery play a role in problematic vessel formation in HFS. METHODS Imaging data of 341 patients with HFS who underwent microvascular decompression were reviewed retrospectively and compared with 360 control subjects. Hemodynamics of typical anatomic variations of the vertebral artery (VA) were analyzed using computational fluid dynamics software. RESULTS Asymmetry of the left and right VAs was prevalent, and the left VA was the most dominant VA. A dominant VA was more prevalent in the HFS group than in the control group (P = 0.026). Left HFS had a significantly higher proportion of a left dominant VA, and right HFS had a significantly higher proportion of a right dominant VA (P < 0.001). Computational fluid dynamics models showed that angulation and tortuosity of vessels caused remarkable pressure difference between vascular walls of opposite sides. Dynamic clinical observations showed the mode of vessel transposition coincided with biomechanical characteristics. CONCLUSIONS Anatomic variations and hemodynamics of the vertebrobasilar arterial system are likely to contribute to vascular compression formation in HFS.
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Affiliation(s)
- Qiang-Ping Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ye Yuan
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nan-Xiang Xiong
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Peng Fu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Huang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Chu
- Institute of Nuclear Science and Engineering, Naval University of Engineering, Wuhan, China
| | - Hong-Yang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Park JS, Koh EJ, Choi HY, Lee JM. Characteristic anatomical conformation of the vertebral artery causing vascular compression against the root exit zone of the facial nerve in patients with hemifacial spasm. Acta Neurochir (Wien) 2015; 157:449-54; discussion 454. [PMID: 25585837 DOI: 10.1007/s00701-014-2338-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) is caused by tortuous offending vessels near the facial nerve root exit zone. However, the definitive mechanism of offending vessel formation remains unclear. We hypothesized that vascular angulation and tortuosity, probably caused by uneven vertebral artery blood flow, result in vascular compression of the facial nerve root exit zone. METHODS The authors observed two anatomical characteristics of the vertebrobasilar arterial system in 120 subjects in the surgical group and 188 controls. The presence of the dominant vertebral artery (DVA) and laterality of the vertebrobasilar junction (VBJ) were observed. We also analyzed the morphological characteristics of the surgical group showing the presence of DVA. The morphological characteristics were classified into three types: type I had the VBJ and DVA on the same side, type II had the VBJ within 2 mm of the midline, and type III had the VBJ opposite the DVA. RESULT The DVA was more prevalent in the surgical group than in the control group (71 % versus 54 %, P < 0.05). The surgical group patients with HFS on the left were more likely to have a DVA on the left (P < 0.05) and with HFS on the right were more likely to have a DVA on the right (P < 0.01) compared with controls. The direction of the VBJ was more common on the same side as the DVA, which corresponds with the laterality of the HFS. In the surgical group with the DVA and HFS on the same side, type I was predominant, but in the surgical group with a contralateral DVA and HFS, type III was predominant. CONCLUSION The presence of a DVA and shifting of the VBJ on the same side plays a role in the angulation and tortuosity of vessels in the perivertebrobasilar junction, resulting in neurovascular compression of the facial nerve root exit zone and thereby causing HFS.
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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] [What about the content of this article? (0)] [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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Choi HJ, Lee SH, Choi SK, Rhee BA. Hemifacial spasm developed after contralateral vertebral artery ligation. J Korean Neurosurg Soc 2012; 51:59-61. [PMID: 22396847 PMCID: PMC3291710 DOI: 10.3340/jkns.2012.51.1.59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 07/06/2011] [Accepted: 01/08/2012] [Indexed: 11/27/2022] Open
Abstract
Although the mechanism of hemifacial spasm (HFS) is not yet well established, vascular compression of the facial nerve root exit zone and hyperexcitability of the facial nucleus have been suggested. We report a case of HFS in the setting of coinciding intracranial hemorrhage (ICH) of the pons and proximal ligation of the contralateral vertebral artery (VA) for the treatment of a fusiform aneurysm of the distal VA and discuss the possible etiologies of HFS in this patient. A 51-year-old male with an ICH of the pons was admitted to our hospital. Neuroimaging studies revealed an incidental fusiform aneurysm of the right VA distal to the origin of the posterior inferior cerebellar artery. Eight months after proximal ligation of the VA the patient presented with intermittent spasm of the left side of his face. Pre- and post-ligation magnetic resonance angiography revealed an enlarged diameter of the VA. The spasm completely disappeared after microvascular decompression.
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Affiliation(s)
- Hyuk Jai Choi
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung Ho Lee
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seok Keun Choi
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Bong Arm Rhee
- 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Murakami H, Kawaguchi T, Fukuda M, Ito Y, Hasegawa H, Tanaka R. Monitoring of the lateral spread response in the endovascular treatment of a hemifacial spasm caused by an unruptured vertebral artery aneurysm. J Neurosurg 2004; 101:861-3. [PMID: 15540928 DOI: 10.3171/jns.2004.101.5.0861] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The lateral spread response (LSR) is used in the electrophysiological diagnosis of a hemifacial spasm or for monitoring during microvascular decompression. The authors used LSRs for intraoperative monitoring during endovascular surgery in a rare case of vertebral artery (VA) aneurysm that caused intractable hemifacial spasm.
A 49-year-old woman presented with a right hemifacial spasm that had persisted for 9 months. No other clinical symptom was observed. Vertebral artery angiography revealed a saccular aneurysm of the right VA. Magnetic resonance (MR) imaging demonstrated that the aneurysm was compressing the root exit zone of the right facial nerve. Endovascular treatment of the VA aneurysm was performed while monitoring the patient's LSRs. During occlusion of the VA at sites distal and proximal to the aneurysm, the LSRs temporarily disappeared and then reappeared with a higher amplitude than those measured preceding their disappearance. The hemifacial spasm alleviated gradually and disappeared completely 6 months after treatment. The LSRs changed in parallel with the improvement in the patient's hemifacial spasms and eventually disappeared. No recurrence of symptoms has been noticed as of 18 months postoperatively.
This is the first report of the use of LSR monitoring during endovascular surgery for an intracranial aneurysm that causes hemifacial spasm. Intraoperative and postoperative changes in the LSRs provided useful information regarding the pathophysiology of hemifacial spasm.
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Affiliation(s)
- Hiroatsu Murakami
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
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14
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Abstract
A case of a delayed-onset post-operative altered sensation of the mental nerve is reported with speculations as to etiology. There is a discussion concerning intraoperative radiographs and osteotomy positioning. When postoperative altered sensation occurs, etiologic considerations should always include local anesthetic administration technique. The importance of pulp testing from the first molar to the contralateral lateral incisor is key to determining whether the deficit is in the mandibular nerve or only the mental nerve, which may be a result of mental block local anesthetic administration and not implant placement. This differentiation may be important in treatment and/or legal exposure. The altered sensation was probably caused by the mental block anesthetic technique. The partial anesthetic area in this case was probably a result of crossover innervation from the contralateral mental nerve.
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