scholarly journals Crocodile tear syndrome post microvascular decompression of the trigeminal nerve: a case report and literature review

2021 ◽  
Author(s):  
Mohammad H Abul
Keyword(s):  
Facial Nerve ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Botulinum Toxin Injection ◽  
Csf Leak ◽  
Decompression Surgery ◽  
First Case ◽  
Initial Surgery ◽  
Long Term Follow Up ◽  
Microvascular Decompression Surgery

Abstract Background Crocodile tear syndrome (CTS) is a condition characterised by excessive tear secretion in response to eating, drinking, or smelling foods. Traditionally, acquired cases are most commonly reported following facial nerve trauma or paralysis, or in slow-growing facial nerve tumours. More recently, it has been reported following vestibular Schwannoma surgery. We report the first case of crocodile tear syndrome following microvascular decompression of the trigeminal nerve. Case presentation A 61-year-old lady presented with excessive lacrimation and clear rhinorrhoea one month post-operatively from a re-do trigeminal microvascular decompression surgery. The patient experienced similar symptoms following her initial surgery two years prior, which had resolved spontaneously. CT and MRI head, and comprehensive clinical examination showed no evidence of CSF rhinorrhoea or cause of her symptoms. An ENT opinion was sought, and the patient was diagnosed with post-operative crocodile tear syndrome.Literature review revealed no reported cases of CTS following microvascular decompression of the trigeminal nerve. Surgical technique and relevant imaging were reviewed for any possible explanation for the condition. Considering the accepted pathogenesis of CTS, we discuss the aetio-pathogenesis for the development of the condition following this procedure. Conclusions We conclude CTS should be considered in patients presenting with rhinorrhoea following microvascular decompression of the trigeminal nerve. In patients presenting with post-operative rhinorrhoea after MVD, after excluding CSF leak, CTS should be considered as a potential differential diagnosis. Treatment for CTS in this context may pose a challenge. The patient has undergone botulinum toxin injection of the lacrimal gland and will need long term follow up. This is the first documented case of CTS post microvascular decompression of the trigeminal nerve.

POLYTETRAFLUOROETHYLENE-INDUCED GRANULOMA AND BRAINSTEM CYST AFTER MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA

Neurosurgery ◽  
2007 ◽  
Vol 61 (4) ◽  
pp. E875-E877 ◽  
Author(s):  
Gabor Toth ◽  
Helene Rubeiz ◽  
R. Loch Macdonald
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Clinical Presentation ◽  
Rare Complication ◽  
Granulomatous Inflammation ◽  
Neurological Deficits ◽  
Decompression Surgery ◽  
Idiosyncratic Reaction ◽  
First Case ◽  
Microvascular Decompression Surgery

Abstract OBJECTIVE Microvascular decompression is commonly performed for medically refractory trigeminal neuralgia. A piece of polytetrafluoroethylene (PTFE) is usually placed between the trigeminal nerve and the blood vessel causing the compression. The procedure is effective and relatively safe, and PTFE is presumed to be inert. Reactions to PTFE are rare. CLINICAL PRESENTATION We report a patient who developed progressive neurological symptoms 5 years after microvascular decompression surgery. Imaging showed an enhancing cerebellopontine mass resembling a posterior fossa tumor with a large cyst compressing the brainstem. INTERVENTION Craniotomy was performed to decompress the cyst. Biopsy of the enhancing mass showed granulomatous inflammation. The patient underwent a second brainstem decompression surgery with placement of a catheter in the cyst connected to an Ommaya reservoir; she has moderate to severe residual neurological deficits. CONCLUSION This may be the first case of a severely disabling, space-occupying cyst resulting from a reaction to intracranial PTFE. Should this exceptionally rare complication be disclosed to patients or is it an idiosyncratic reaction unlikely to occur again?

Interventional Neuroradiology in Hemifacial Spasm

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 32-36 ◽  
Author(s):  
K. Yamashita ◽  
S. Okamoto ◽  
K. Hosotani ◽  
S. Nakatsu ◽  
M. Hojo ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Contrast Material ◽  
Interventional Neuroradiology ◽  
Decompression Surgery ◽  
Neurovascular Compression ◽  
Root Exit Zone ◽  
Functional Investigation ◽  
Microvascular Decompression Surgery

There have never been functional studies in the diagnosis of hemifacial spasm caused by neurovascular compression. We used neurointerventional techniques to conduct a functional investigation of the artery responsible for hemifacial spasm in seven patients. A microcatheter was inserted into the various arteries of the posterior circulation under systemic heparinization, and its effect on the spasm was evaluated clinically and electromyographically. In six patients who underwent microvascular decompression surgery, the vessels compressing the root exit zone of the facial nerve were surgically determined, and compared with the result of the procedure. The catheter was inserted into twelve arteries. The spasms were stopped immediately and completely by the insertion of the catheter into seven arteries. Six of them were surgically proven to compress the root exit zone of the facial nerve. The spasm was changed in frequency or in type by the insertion into two arteries. These arteries were also compressing the root exit zone. One artery was located at a more peripheral part of it and the other was running over another artery compressing the root exit zone. The spasms were not affected at all by the insertion into three arteries. These arteries were not observed in the operative field and had no contact with the nerve. Superselective ‘angiograms showedpositional qnd configurational changes of the arteries. There was no arterial spasm and tight catheterization leading to stasis of contrast material within the arteries. There were no complications related to the procedures. Functional relationship between the artery and the spasms was established in all the patients, and one patient refused surgery because the frequency of the spasm was reduced by the procedure. The result of this study may suggest that a functional investigation of hemifacial spasm is feasible and seems useful for selecting good candidates for microvascular decompression surgery.

scholarly journals Penetrating Offending Vessel, The Most Surgically Demanding Type during Microvascular Decompression Surgery in Hemifacial Spasm

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Seunghoon Lee ◽  
Kwan Park
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Decompression Surgery ◽  
Neurovascular Compression ◽  
Extent Of Surgery ◽  
Free Running ◽  
The One ◽  
Microvascular Decompression Surgery

Abstract INTRODUCTION Microvascular decompression (MVD) is the most effective and curative treatment option for neurovascular compression syndrome and it is increasingly performed around the world. This study aimed to identify and describe the most technically difficult cases, which were the patients with penetrating offending vessel through the facial nerve, from our experiences and to give surgical tips for the successful MVD. METHODS Surgical records and intraoperative video of hemifacial spasm patients with penetrating offending vessels were reviewed. Interposition of Teflon felt between nerve and vessel was pursued, and neurectomy was avoided as much as possible. RESULTS Five patients with hemifacial spasm were identified as having a penetrating offending vessel through the facial nerve during the last 5 yr of MVD surgery in our institution. Four AICAs and one PICA were the causative vessels. Partial neurectomy was required in 1 patient. During the median follow-up of 6 mo (range, 1-26), all patients were spasm-free. No patients including the one with partial neurectomy were involved in facial palsy or hearing loss. CONCLUSION MVD in HFS patients with penetrating offending vessel through the facial nerve is the most surgically challenging and demands a high surgical skill. Interposition with Teflon felt is effective and neurectomy should be avoided. Intraoperative monitoring of free-running EMG and abnormal muscle response are helpful to decide the extent of surgery.

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