Hemifacial Spasm Caused by a Venule: Case Report

Neurosurgery ◽  
1984 ◽  
Vol 14 (1) ◽  
pp. 89-92 ◽  
Author(s):  
Peter J. Jannetta
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Blood Vessels ◽  
Hemifacial Spasm ◽  
Vascular Compression ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Facial Spasm ◽  
Posterior Direction ◽  
Anterior Posterior

Abstract The syndrome of hemifacial spasm occurs as a consequence of compression, almost universally by blood vessels, of the root entry zone of the facial nerve. The vascular compression is usually obvious at operation, but may be subtle. The author describes a case in which a venule running in an anterior-posterior direction across the caudal aspect of the root entry zone of the facial nerve, which was thought to be causing the spasm, was coagulated and divided. A small, more distal arteriole, probably not contributory, was decompressed away from the nerve. After operation, the patient improved gradually, and she remains free of facial spasm or weakness. This is the most subtle vascular compression seen by the author and his colleagues in over 400 microvascular decompressions for hemifacial spasm.

scholarly journals Hemifacial spasm secondary to middle ear cholesteatoma

2018 ◽  
Vol 97 (6) ◽  
pp. E31-E32
Author(s):  
Maheep Sohal ◽  
Nicholas Karter ◽  
Marc Eisen
Keyword(s):  
Facial Nerve ◽  
Middle Ear ◽  
Hemifacial Spasm ◽  
Final Diagnosis ◽  
Computed Tomographic Angiography ◽  
Vascular Compression ◽  
Computed Tomographic ◽  
Middle Ear Cholesteatoma ◽  
Facial Spasm ◽  
Tomographic Angiography

Hemifacial spasm is a peripheral myoclonus of the VIIth cranial nerve that is characterized by paroxysmal contraction of the muscles of facial expression. It exists in both primary and secondary forms. In rare cases, hemifacial spasm is caused by middle ear pathology. We describe the case of a 90-year-old man with recurrent cholesteatoma and tympanic segment fallopian canal dehiscence manifesting as right-sided hemifacial spasm. His history was significant for a right-sided tympanomastoidectomy for cholesteatoma 6 years earlier. Computed tomographic angiography performed to look for vascular compression of the facial nerve demonstrated a right middle ear opacification. Middle ear exploration revealed a completely dehiscent tympanic segment with cholesteatoma abutting the facial nerve. The overlying keratin debris and matrix were carefully dissected off, and facial nerve function was preserved. The final diagnosis was hemifacial spasm. During 14 months of postoperative follow-up, the patient experienced no further facial spasm.

“Macrovascular” Decompression of Dolichoectatic Vertebral Artery Causing Hemifacial Spasm Using Goretex Sling: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. 267-268 ◽  
Author(s):  
Stephan A Munich ◽  
Jacques J Morcos
Keyword(s):  
Facial Nerve ◽  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Orbicularis Oculi ◽  
Entry Zone ◽  
Common Cause ◽  
Root Entry Zone ◽  
Offending Artery ◽  
Key Steps

Abstract Hemifacial spasm is characterized by painless and involuntary spasms of the muscles supplied by the facial nerve, most commonly involving the orbicularis oculi. The most common cause of hemifacial spasm is compression of the facial nerve's root by the anterior inferior, or posterior inferior, cerebellar arteries (AICA or PICA). However, in <1% of cases, the compression can be due to a dolichoectatic vertebral artery. Microvascular decompression using Teflon patties may be sufficient when the offending artery is small (eg, AICA or PICA). However, the size and tortuosity of the vertebral artery (especially one that is dolichoectatic) may require a more robust means of decompression (ie, “macrovascular decompression”).  In this operative video we demonstrate our technique for managing a patient with hemifacial spasm due to a dolicoectatic vertebral artery. We use a Goretex® (W.L. Gore & Associates Inc, Newark, Delaware) sling secured to the dura of the posterior petrous ridge to suspend the vertebral and posterior inferior cerebellar arteries, thereby decompressing the root entry zone of the facial nerve. Teflon felt pieces are added as a second layer of security. Key steps to this technique include: (1) visualization of the root entry zone, (2) extensive arachnoid dissection to allow adequate mobilization of the vertebral artery, 12 and (3) securing the sling in a trajectory that prevents kinking of the vertebral artery and its branches.

scholarly journals Trigeminal Neuralgia associated with Wallenberg Syndrome, a case report

2021 ◽  
Author(s):  
Matheus Goncalves Maia ◽  
Vivian Dias Baptista Gagliardi ◽  
Francisco Tomaz Meneses Oliveira ◽  
Eduardo dos Santos Sousa ◽  
Marina Trombin Marques ◽  
...  
Keyword(s):  
Case Report ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Vascular Compression ◽  
Gasserian Ganglion ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Initial Event ◽  
The Right ◽  
The Brain

Context: Trigeminal neuralgia is typically associated with structural lesions that affect the brainstem, pre-ganglionic roots, gasserian ganglion and the trigeminal nerve. The association of trigeminal neuralgia with infarction of the dorsolateral medulla is rare, being more associated with pontine lesions, in the context of brainstem infarction. Methods: Report the case of a 55-year-old male patient, who presented with a left dorsolateral bulbar infarction, and developed a ipsilateral trigeminal neuralgia afterwards. Case report: A 55-year-old man attended to the emergency room referring sudden incoordination of the left limbs, associated with numbness of the contralateral limbs. The neurological examination showed nystagmus, numbness of the left face, ataxia of the left limbs and numbness of the right limbs. The Magnetic Resonance of the Brain revealed an area of recent infarction in the left posterolateral aspect of the medulla. He underwent thrombolysis, evolving with complete resolution of symptoms. In the week after the initial event, he returned to the outpatient clinic, reporting paroxysms of excruciating pain in the upper lip, nose and left zygomatic region, being diagnosed with neuralgia of the maxillary segment of the trigeminal nerve, improving with introduction of Gabapentin. Conclusion: Although most cases of trigeminal neuralgia are determined by vascular compression of the trigeminal nerve root entry zone, other causes must be considered. The association of this condition with dorsolateral medulla infarction is rare, with only 4 cases reported in the last 10 years.

Role of Postoperative Magnetic Resonance Imaging after Microvascular Decompression of the Facial Nerve for the Treatment of Hemifacial Spasm

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 720-726 ◽  
Author(s):  
Jin Woo Chang ◽  
Jong Hee Chang ◽  
Jae Young Choi ◽  
Dong Ik Kim ◽  
Yong Gou Park ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Short Range ◽  
Three Dimensional ◽  
Resonance Imaging ◽  
Entry Zone ◽  
Root Entry Zone

Abstract OBJECTIVE: This study was performed to investigate the role of postoperative three-dimensional short-range magnetic resonance angiography in the prediction of clinical outcomes after microvascular decompression (MVD) for the treatment of hemifacial spasm. METHODS: We examined pre- and postoperative magnetic resonance imaging scans obtained between March 1999 and May 2000 for 122 patients with hemifacial spasm, to evaluate the degree of detachment of the vascular contact and changes in the positions of offending vessels. The degree of vascular decompression of the facial nerve root was classified into three groups, i.e., contact, partial decompression, or complete decompression. Contact was defined as unresolved compression, as indicated by postoperative three-dimensional short-range magnetic resonance angiography. Partial decompression was defined as incompletely resolved compression; vascular indentation of the facial nerve was improved, but contact with the facial nerve remained. Complete decompression was defined as completely resolved compression. These findings were compared with the surgical findings and clinical outcomes. RESULTS: Of 122 patients with MVD, complete decompression of offending vessels at the root entry zone of the facial nerve was observed for 106 patients (86.9%), partial decompression was observed for 10 patients (8.2%), and contact with offending vessels was observed for 6 patients (4.9%) by using postoperative three-dimensional short-range magnetic resonance angiography. Our study demonstrated that the types of offending vessels affected neither the degree of decompression of the root entry zone of the facial nerve nor surgical outcomes (P > 0.05). Also, there was no significant relationship between the degree of decompression and improvement of symptoms (P > 0.05). Furthermore, there was no significant relationship between the degree of decompression and the timing of symptomatic improvement (P > 0.05). CONCLUSION: Our data suggest that MVD of the facial nerve alone may not be sufficient to resolve symptoms for all patients with hemifacial spasm. Therefore, unknown factors in addition to vascular compression may cause symptoms in certain cases, and it may be necessary to remove those factors, simultaneously with MVD, to obtain symptom resolution.

scholarly journals Hemifacial Spasm and Neurovascular Compression

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Alex Y. Lu ◽  
Jacky T. Yeung ◽  
Jason L. Gerrard ◽  
Elias M. Michaelides ◽  
Raymond F. Sekula ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Nerve Root ◽  
Age Of Onset ◽  
Symptomatic Relief ◽  
Disease Process ◽  
Vascular Compression ◽  
Neurovascular Compression ◽  
Root Entry Zone ◽  
Magnetic Resonance Imaging Mri

Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Its prevalence is 9.8 per 100,000 persons with an average age of onset of 44 years. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone of the facial nerve. HFS can be divided into two types: primary and secondary. Primary HFS is triggered by vascular compression whereas secondary HFS comprises all other causes of facial nerve damage. Clinical examination and imaging modalities such as electromyography (EMG) and magnetic resonance imaging (MRI) are useful to differentiate HFS from other facial movement disorders and for intraoperative planning. The standard medical management for HFS is botulinum neurotoxin (BoNT) injections, which provides low-risk but limited symptomatic relief. The only curative treatment for HFS is microvascular decompression (MVD), a surgical intervention that provides lasting symptomatic relief by reducing compression of the facial nerve root. With a low rate of complications such as hearing loss, MVD remains the treatment of choice for HFS patients as intraoperative technique and monitoring continue to improve.

scholarly journals Hemifacial Spasm and Craniovertebral Anomaly

1990 ◽  
Vol 17 (4) ◽  
pp. 424-426 ◽  
Author(s):  
F.B. Maroun ◽  
J.C. Jacob ◽  
B.K.A. Weir ◽  
M.A. Mangan
Keyword(s):  
Congenital Anomaly ◽  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Craniovertebral Junction ◽  
Entry Zone ◽  
Complete Cessation ◽  
Root Entry Zone ◽  
Craniovertebral Anomaly

ABSTRACT:Two patients with congenital anomaly of the craniovertebral junction causing disabling hemifacial spasm (HFS) are presented. In one patient, complete cessation of the HFS occurred for a period of two years following simple bony decompression of the craniovertebral junction raising unanswered questions as to the exact pathogenesis of HFS. Eventually both patients required microvascular decompression at the root entry zone of the facial nerve.

scholarly journals ACUPUNCTURE AND SELF ACUPRESSURE TREATMENT OF HEMIFACIAL SPASM: A CASE REPORT

2020 ◽  
Vol 4 (1) ◽  
pp. 12
Author(s):  
Maya Septriana ◽  
Yudi Perdana
Keyword(s):  
Case Report ◽  
Hemifacial Spasm ◽  
Biochemical Mechanism ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Auricular Acupressure ◽  
Strong Stimulation ◽  
The Face ◽  
Vascular Loop ◽  
Stimulation Of

Background: Hemifacial spasm (HFS) is a condition of unilateral, involuntary, irregular, spasmodic movements of the face. The condition is most commonly a result of vascular loop compression at the root entry zone of the facial nerve. Patient whose hemifacial spasm with  left-sided facial complaints often twitching since 6 months ago. This   69-year-old  man with hyperlipidemia and hypertension had diagnosed with hemifacial spasm by neurologist. Purpose: To prove the effect of acupuncture on Fengchi (GB 20), Neiguan (PC 6) and Taichong (LR 3) accompanied with acupressure on Taichong (LR 3)  and auricular acupressure on the Ear Shenmen point in patient with hemifacial spasm. Methods: Handling Hemifacial spasm with acupuncture on Fengchi (GB 20), Neiguan (PC 6) and Taichong (LR 3)  with the reducing method and strong stimulation three times a week, acupressure on the Taichong (LR 3) twice a day for 30 times pressure and auricular acupressure on ear Shenmen, twice a day for 5 minutes. Results: Biochemical  mechanism of acupuncture and acupressure involve the stimulation of acupoint that lead to complex neuro-hormonal response. In handling hemifacial spasm, acupunture given for 15 times, taken three times a week combined with acupressure and auricular acupressure. This therapy overcome the symptoms of facial twitching in hemifacial spasm. Conclusion: Acupuncture combined with acupressure and auricular acupressure can be used to overcome facial twitching in hemifacial spasm.

Chiari Type I Malformation Presenting as Hemifacial Spasm: Case Report

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. E371-E371 ◽  
Author(s):  
Mustafa Efkan Colpan ◽  
Zeki Sekerci
Keyword(s):  
Facial Nerve ◽  
Posterior Fossa ◽  
Hemifacial Spasm ◽  
Chiari I Malformation ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Type I Malformation ◽  
Downward Displacement ◽  
Facial Spasm ◽  
Chiari I

ABSTRACT OBJECTIVE AND IMPORTANCE: We report on a patient with a Chiari I malformation presenting with right hemifacial spasm. Clinicians should consider the downward displacement of the hindbrain as a rare cause of hemifacial spasm in Chiari I malformation. CLINICAL PRESENTATION: An 18-year-old man was admitted with right hemifacial spasm. The results of the neurological examination were normal except for the facial spasm. Magnetic resonance imaging demonstrated a Chiari I malformation without syringomyelia. After surgery, the hemifacial spasm completely resolved. INTERVENTION: Posterior fossa decompression, C1 laminectomy, and duraplasty were performed. CONCLUSION: The hemifacial spasm could be attributed to compression and/or traction of the facial nerve because of downward displacement of the hindbrain in Chiari I malformation. Compression and/or traction might create irritation of the facial nerve that causes hemifacial spasm. Resolution of the hemifacial spasm after posterior fossa decompression could explain the facial nerve irritation in Chiari I malformation. Clinicians should consider Chiari malformation as a cause of hemifacial spasm and posterior fossa decompression as a potential treatment.

scholarly journals Hemi facial Spasm Resulting from Facial Nerve Compression Near the Internal Acoustic Meatus —Case Report—

1997 ◽  
Vol 37 (10) ◽  
pp. 771-774 ◽  
Author(s):  
Masafumi FUKUDA ◽  
Shigeki KAMEYAMA ◽  
Yoshiho HONDA ◽  
Ryuichi TANAKA
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Nerve Compression ◽  
Internal Acoustic Meatus ◽  
Facial Spasm

Pathophysiology of trigeminal neuralgia: new evidence from a trigeminal ganglion intraoperative microneurographic recording

2004 ◽  
Vol 101 (5) ◽  
pp. 872-873 ◽  
Author(s):  
Kim J. Burchiel ◽  
Thomas K. Baumann
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Ganglion ◽  
Physiological Mechanism ◽  
Vascular Compression ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Trigeminal Ganglion Neurons ◽  
Ganglion Neurons ◽  
New Evidence

✓ The origin of trigeminal neuralgia (TN) appears to be vascular compression of the trigeminal nerve at the root entry zone; however, the physiological mechanism of this disorder remains uncertain. The authors obtained intraoperative microneurographic recordings from trigeminal ganglion neurons in a patient with TN immediately before percutaneous radiofrequency-induced gangliolysis. Their findings are consistent with the idea that the pain of TN is generated, at least in part, by an abnormal discharge within the peripheral nervous system.

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