Spasmodic Torticollis Due to Neurovascular Compression of the Spinal Accessory Nerve by the Anteroinferior Cerebellar Artery: Case Report

Neurosurgery ◽  
2000 ◽  
Vol 47 (3) ◽  
pp. 768-772 ◽  
Author(s):  
Concetta Alafaci ◽  
Francesco M. Salpietro ◽  
Gaspare Montemagno ◽  
Giovanni Grasso ◽  
Francesco Tomasello
Keyword(s):  
Cranial Nerve ◽  
Neuromuscular Disorder ◽  
Spasmodic Torticollis ◽  
Accessory Nerve ◽  
Decompression Surgery ◽  
Neurovascular Compression ◽  
Cerebellar Artery ◽  
History Of ◽  
Microvascular Decompression Surgery ◽  
The Right

ABSTRACT OBJECTIVE AND IMPORTANCE Spasmodic torticollis is a neuromuscular disorder characterized by uncontrollable clonic and intermittently tonic spasm of the neck muscles. We report a case of spasmodic torticollis attributable to neurovascular compression of the right XIth cranial nerve by the right anteroinferior cerebellar artery (AICA). CLINICAL PRESENTATION A 72-year-old man with a 2-year history of right spasmodic torticollis underwent magnetic resonance imaging, which demonstrated compression of the right XIth cranial nerve by an abnormal descending loop of the right AICA. INTERVENTION The patient underwent microvascular decompression surgery. During surgery, it was confirmed that an abnormal loop of the right AICA was compressing the right accessory nerve. Compression was released by the interposition of muscle between the artery and the nerve. CONCLUSION The patient's postoperative course was uneventful, and his symptoms were fully relieved at the 2-year follow-up examination. This is the first reported case of spasmodic torticollis attributable to compression by the AICA; usually, the blood vessels involved are the vertebral artery and the posteroinferior cerebellar artery.

Spasmodic Torticollis Due to Neurovascular Compression of the Spinal Accessory Nerve by the Anteroinferior Cerebellar Artery: Case Report

Neurosurgery ◽  
2000 ◽  
Vol 47 (3) ◽  
pp. 768-772 ◽  
Author(s):  
Concetta Alafaci ◽  
Francesco M. Salpietro ◽  
Gaspare Montemagno ◽  
Giovanni Grasso ◽  
Francesco Tomasello
Keyword(s):  
Case Report ◽  
Spasmodic Torticollis ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Neurovascular Compression ◽  
Spinal Accessory ◽  
Cerebellar Artery

Spasmodic torticollis due to neurovascular compression of the 11th nerve

1985 ◽  
Vol 63 (5) ◽  
pp. 789-791 ◽  
Author(s):  
Carlo A. Pagni ◽  
Michele Naddeo ◽  
Giuliano Faccani
Keyword(s):  
Unusual Case ◽  
Spasmodic Torticollis ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Neurovascular Compression ◽  
Content Type ◽  
Spinal Accessory ◽  
Cerebellar Artery ◽  
Fine Print

✓ An unusual case of spasmodic torticollis caused by posteroinferior cerebellar artery compression of the spinal accessory nerve is reported. The spasmodic torticollis was cured by abolishing the neurovascular compression.

scholarly journals Extreme Lateral Supracerebellar Infratentorial Approach to the Lateral Midbrain

2018 ◽  
Vol 79 (S 05) ◽  
pp. S415-S417
Author(s):  
M. Kalani ◽  
William Couldwell
Keyword(s):  
Cranial Nerves ◽  
Sudden Onset ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Cerebellar Artery ◽  
Sensory Disturbances ◽  
History Of ◽  
Supracerebellar Infratentorial Approach ◽  
The Right ◽  
Piecemeal Resection

This video illustrates the case of a 52-year-old man with a history of multiple bleeds from a lateral midbrain cerebral cavernous malformation, who presented with sudden-onset headache, gait instability, and left-sided motor and sensory disturbances. This lesion was eccentric to the right side and was located in the dorsolateral brainstem. Therefore, the lesion was approached via a right-sided extreme lateral supracerebellar infratentorial (exSCIT) craniotomy with monitoring of the cranial nerves. This video demonstrates the utility of the exSCIT for resection of dorsolateral brainstem lesions and how this approach gives the surgeon ready access to the supracerebellar space, and cerebellopontine angle cistern. The lateral mesencephalic safe entry zone can be accessed from this approach; it is identified by the intersection of branches of the superior cerebellar artery and the fourth cranial nerve with the vein of the lateral mesencephalic sulcus. The technique of piecemeal resection of the lesion from the brainstem is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem.The link to the video can be found at: https://youtu.be/aIw-O2Ryleg.

Laparoscopic surgical approach for the treatment of piriformis syndrome: Intrapelvic decompression technique

2021 ◽  
pp. 228402652110456
Author(s):  
Ahmet Kale ◽  
Gülfem Başol ◽  
Elif Cansu Gündoğdu ◽  
Emre Mat ◽  
Gazi Yıldız ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Decompression Surgery ◽  
Piriformis Syndrome ◽  
First Case ◽  
Cutaneous Allodynia ◽  
Pelvic Nerves ◽  
Uncommon Disease ◽  
History Of ◽  
Vas Scores ◽  
The Right

Introduction: Piriformis syndrome is an uncommon disease resulting from the piriformis muscle’s compression of the sciatic nerve. Pain and numbness in the buttocks and down the leg are the most common symptoms. This study analyzes the laparoscopic surgical treatment of piriformis syndrome. Methods: We report three cases of piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back pain and sciatica on her right side. Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The second case was a 30 years old woman with a 2-year history of sciatica on her left side. The third case was a 30 years old woman with a 2-year history of sciatica on her right side. All the patients underwent laparoscopic decompression surgery, which was performed to release the sciatic nerve or sacral nerve roots. Results: The patients were reexamined at the postoperative 3rd and 6th months. Their visual analog scale (VAS) scores were found to be decreased from 10/10, 9/10, and 7/10 to 0/10, 1/10, and 0/10, respectively. Conclusion: Due to the very few cases in the literature, pelvic piriformis syndrome is an exclusively clinical diagnosis. If the sciatica is refractory to conservative treatments, laparoscopic exploration and decompression surgery of the pelvic nerves and piriformis muscle could be an option.

Microsurgical Treatment of Glossopharyngeal Neuralgia: Case Reports

Neurosurgery ◽  
1989 ◽  
Vol 25 (4) ◽  
pp. 630-632 ◽  
Author(s):  
Bernardo Fraioli ◽  
Vincenzo Esposito ◽  
Luigi Ferrante ◽  
Lanfranco Trubiani ◽  
Pierpaolo Lunardi
Keyword(s):  
Vagus Nerve ◽  
Cranial Nerve ◽  
Open Surgery ◽  
Case Reports ◽  
Cranial Nerves ◽  
Posterior Cranial Fossa ◽  
Glossopharyngeal Neuralgia ◽  
Neurovascular Compression ◽  
Cerebellar Artery ◽  
Cranial Fossa

Abstract Three patients with excruciating glossopharyngeal neuralgia underwent microsurgical operations in the posterior cranial fossa. In each patient, neurovascular compression was found involving the posteroinferior cerebellar artery and involving the 9th and 10th cranial nerves. In two of the patients, the compression was caused by arachnoiditis and in the other by an arterial loop. In each patient, neuralgia was successfully eliminated by microvascular decompression and by section of the upper rootlets of the vagus nerve. In one patient, partial section of the 9th cranial nerve was also performed. Because of the frequent involvement of the vagus nerve in the pathogenesis of this condition, open surgery should be preferable to percutaneous thermorhizotomy, which is unable to act selectively on the 10th cranial nerve.

scholarly journals Microvascular decompression for a unique case of glossopharyngeal neuralgia with provokable symptomatic bradycardia: 2-Dimensional operative video

2021 ◽  
Vol 12 ◽  
pp. 570
Author(s):  
Tejas Arvind Sardar ◽  
Viren S. Vasudeva ◽  
M. Neil Woodall
Keyword(s):  
Microvascular Decompression ◽  
Video Recording ◽  
External Auditory Meatus ◽  
Glossopharyngeal Neuralgia ◽  
Neurovascular Compression ◽  
History Of ◽  
Craniofacial Pain ◽  
Symptomatic Bradycardia ◽  
The Right ◽  
Video Case Report

Background: Glossopharyngeal neuralgia is a rare neurovascular compression syndrome that can lead to paroxysmal craniofacial pain and sometimes cardiovascular symptoms.[1,2] The characteristic pathology involves a vessel (commonly a branch/loop of PICA) compressing the nerve at the root entry/exit zone at the brainstem.[1] Microvascular decompression is a commonly used treatment approach for patients that have failed conservative measures.[2] Case Description: A 72-year-old male presented to the ED following four episodes of syncope. The patient had a multi-year history of right-sided burning/stabbing pain involving the submandibular area and posterior throat. His syncope was related to symptomatic bradycardia that would occur during episodes of pain. His pain was exacerbated by speaking and swallowing and could be triggered by placing his finger in the right external auditory meatus. Interestingly, this maneuver would also trigger his bradycardia. The patient had failed previous pharmacotherapy, and a pacemaker had been placed to protect him from periods of hypotension. MRI/MRA of the brain and cervical spine were unremarkable. Due to his profoundly symptomatic status, the patient was offered a right retrosigmoid craniotomy for microvascular decompression of the right glossopharyngeal nerve. The patient had complete resolution of his pain and bradycardia immediately post-operatively. He was discharged on the second postoperative day and his pacemaker was ultimately removed. The patient continues to be pain free and off medication. Conclusion: Here we present a video case report of microvascular decompression with favorable outcome for an interesting presentation of glossopharyngeal neuralgia. The patient gave informed consent for surgery and video recording.

scholarly journals Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations

2016 ◽  
Vol 124 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Mark Gregory Bigder ◽  
Anthony M. Kaufmann
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Senior Author ◽  
Decompression Surgery ◽  
Neurovascular Compression ◽  
Exit Point ◽  
Root Exit Zone ◽  
Prior Surgery ◽  
Microvascular Decompression Surgery

OBJECT Microvascular decompression (MVD) surgery for hemifacial spasm (HFS) is potentially curative. The findings at repeat MVD in patients with persistent or recurrent HFS were analyzed with the aim to identify factors that may improve surgical outcomes. METHODS Intraoperative findings were determined from review of dictated operative reports and operative diagrams for patients who underwent repeat MVD after prior surgery elsewhere. Clinical follow-up was obtained from the hospital and clinic records, as well as telephone questionnaires. RESULTS Among 845 patients who underwent MVD performed by the senior author, 12 had been referred after prior MVD for HFS performed elsewhere. Following repeat MVD, all patients improved and complete spasm resolution was described by 11 of 12 patients after a mean follow-up of 91 ± 55 months (range 28–193). Complications were limited to 1 patient with aggravation of preexisting hearing loss and mild facial weakness and 1 patient with aseptic meningitis without sequelae. Significant factors that may have contributed to the failure of the first surgery included retromastoid craniectomies that did not extend laterally to the sigmoid sinus or inferiorly to the posterior fossa floor in 11 of 12 patients and a prior surgical approach that focused on the cisternal portion of the facial nerve in 9 of 12 patients. In all cases, significant persistent neurovascular compression (NVC) was evident and alleviated more proximally on the facial root exit zone (fREZ). CONCLUSIONS Most HFS patients will achieve spasm relief with thorough alleviation of NVC of the fREZ, which extends from the pontomedullary sulcus root exit point to the Obersteiner-Redlich transition zone.

Vertebral Artery-Posteroinferior Cerebellar Artery Aneurysms: Clinical and Lower Cranial Nerve Outcomes in 52 Patients

Neurosurgery ◽  
2005 ◽  
Vol 56 (1) ◽  
pp. 2-11 ◽  
Author(s):  
Hisham Al-khayat ◽  
Haitham Al-Khayat ◽  
Joseph Beshay ◽  
David Manner ◽  
Jonathan White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Natural History ◽  
Vertebral Artery ◽  
Nosocomial Pneumonia ◽  
Cranial Nerve ◽  
Lower Cranial Nerve ◽  
Cerebellar Artery ◽  
History Of ◽  
Pica Aneurysms

AbstractOBJECTIVE:To identify factors predictive of postoperative lower cranial nerve palsy (LCNP) among patients undergoing surgery for vertebral artery (VA)- posteroinferior cerebellar artery (PICA) aneurysms. The natural history of this LCNP is defined, and its effect on postoperative patient course is analyzed. No similar study has been described in the literature.METHODS:Fifty-two patients with VA-PICA aneurysms, who were treated surgically between 1996 and 2002, were retrospectively studied to identify factors contributing to postoperative LCNP. The effect of LCNP on intensive care unit stay and development of nosocomial pneumonia also was analyzed. All analyses were performed with Fisher's exact test.RESULTS:Postoperative LCNP occurred in 25 patients (48.1%) with VA-PICA aneurysms. Of the factors investigated, the use of temporary or total occlusion was associated with increased incidence of postoperative LCNP (P < 0.001). The average length of stay in the intensive care unit was 13.8 days for patients with LCNP defined as moderate to severe, compared with 7.92 days for patients with LCNP defined as none or mild (P = 0.0014). Nosocomial pneumonia occurred only in patients with moderate to severe LCNP (P = 0.022). Postoperative LCNP resolved completely within 3 months in 12 patients (48%) and within 6 months in 19 patients (76%).CONCLUSION:The results of this study can help to identify the effect and natural history of LCNP after surgical clipping of VA-PICA aneurysms. This information may assist neurosurgeons in expediting treatment, decrease the cost and length of hospital stays, and result in improved outcomes.

scholarly journals Angiographically occult vascular malformation of the intracranial accessory nerve: case report

2016 ◽  
Vol 125 (1) ◽  
pp. 167-172
Author(s):  
Sergei Terterov ◽  
Nancy McLaughlin ◽  
Harry Vinters ◽  
Neil A. Martin
Keyword(s):  
Vascular Malformation ◽  
Vascular Malformations ◽  
Cranial Nerves ◽  
Final Diagnosis ◽  
Brain Parenchyma ◽  
Accessory Nerve ◽  
Not Otherwise Specified ◽  
History Of ◽  
The Right ◽  
Cerebral Vascular Malformations

Angiographically occult cerebral vascular malformations (AOVMs) are usually found in the supratentorial brain parenchyma. Uncommonly, AOVMs can be found within the cavernous sinus or basal cisterns and can be associated with cranial nerves. AOVMs involving the intracranial segment of the spinal accessory nerve have not been described. A 46-year-old female patient presented with a history of episodic frontal headaches and episodes of nausea and dizziness, as well as gait instability progressing over 6 months prior to evaluation. Imaging revealed a well-circumscribed 3-cm extraaxial T1-weighted isointense and T2-weighted hyperintense contrast-enhancing mass centered in the region of the right lateral cerebellomedullary cistern. The patient underwent resection of the lesion. Although the intraoperative appearance was suggestive of a cavernous malformation, some histological findings were atypical, leading to the final diagnosis of vascular malformation, not otherwise specified. The patient’s postoperative course was uneventful with complete resolution of symptoms. To the authors’ knowledge, this is the first report of an AOVM involving the intracranial portion of the accessory nerve. For any AOVM located within the cerebellomedullary cistern or one suspected of involving a cranial nerve, the authors recommend including immunohistochemistry with primary antibody to neurofilament in the histopathology workup.

scholarly journals Current neurosurgical management of glossopharyngeal neuralgia and technical nuances for microvascular decompression surgery

2013 ◽  
Vol 34 (3) ◽  
pp. E8 ◽  
Author(s):  
Roberto Rey-Dios ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Pain Syndrome ◽  
Glossopharyngeal Neuralgia ◽  
Decompression Surgery ◽  
Delay In Diagnosis ◽  
Root Exit Zone ◽  
Microvascular Decompression Surgery

Glossopharyngeal neuralgia (GPN) is an uncommon facial pain syndrome often misdiagnosed as trigeminal neuralgia. The rarity of this condition and its overlap with other cranial nerve hyperactivity syndromes often leads to a significant delay in diagnosis. The surgical procedures with the highest rates of pain relief for GPN are rhizotomy and microvascular decompression (MVD) of cranial nerves IX and X. Neurovascular conflict at the level of the root exit zone of these cranial nerves is believed to be the cause of this pain syndrome in most cases. Vagus nerve rhizotomy is usually reserved for cases in which vascular conflict is not evident. A review of the literature reveals that although the addition of cranial nerve X rhizotomy may improve the chances of long-term pain control, this maneuver also increases the risk of permanent dysphagia and vocal cord paralysis. The risks of this procedure have to be carefully weighed against its benefits. Based on the authors' experience, careful patient selection with a thorough exploratory operation most often leads to identification of the site of vascular conflict, obviating the need for cranial nerve X rhizotomy.

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