Hemifacial Spasm ; etiology ; surgery ; Humans ; Trigeminal Neuralgia ; etiology ; surgery

Female ; Hemifacial Spasm ; etiology ; Humans ; Male ; Mastoiditis ; complications ; Middle Aged

A case is presented of painful tic convulsif caused by schwannoma in the cerebellopontine angle (CPA), with right trigeminal neuralgia and ipsilateral hemifacial spasm. Magnetic resonance images showed a 4 cm round mass displacing the 4th ventricle and distorting the brain stem in the right CPA. The schwannoma, which compressed the fifth and seventh cranial nerves directly, was subtotally removed by a suboccipital craniectomy. Postoperatively, the patient had a complete relief from the hemifacial spasm and marked improvement from trigeminal neuralgia. The painful tic convulsif in this case was probably produced by the tumor compressing and displacing the anterior cerebellar artery directly.
Case Report ; Cerebellar Neoplasms/complications* ; Cerebellopontine Angle* ; Female ; Hemifacial Spasm/etiology* ; Human ; Middle Age ; Neurilemmoma/complications* ; Trigeminal Neuralgia/etiology*

BACKGROUNDMicrovascular Decompression (MVD) operation is the most reliable treatment for hemifacial spasm (HFS), but it causes many complications. The aim of this retrospective study was to investigate the factors relavent to the effects and postoperative complications of microvascular decompression on hemifacial spasm.

METHODSA total of 1200 HFS patients treated with MVD were studied retrospectively. The root exit zone (REZ) of the facial nerve was exposed through the infraflocculus approach, the offending vessels were identified and separated from the REZ, and a Teflon graft was interposed between the offending vessels and the brain stem. Brain stem auditory evoked potential (AEP) was monitored intraoperatively.

RESULTSThe offending vessels can be identified in all patients. The anteroinferior cerebellar artery was the main offending vessel (42.6%). Patients with vertebral artery compression had a multiple vascular compression fashion. Follow-up for 2 - 10 years (mean 4.2 years) showed that 88.7% patients were cured and 5.6% relieved, with an effective rate of 94.3%. Recurrence rate was 3.2%, and the ineffective rate was 2.6%. The most frequent complication was hearing dysfunction (2.8%).

CONCLUSIONSMVD is the most definitive treatment method of HFS. The key procedures of this operation include adequate exposure of the REZ, identification of the offending vessels, and proper positioning of Teflon grafts. Complications can be reduced effectively by utilizing a real-time AEP monitoring during the operation.

Adult ; Aged ; Decompression, Surgical ; adverse effects ; Female ; Hemifacial Spasm ; surgery ; Humans ; Male ; Microsurgery ; Middle Aged ; Postoperative Complications ; etiology ; Retrospective Studies

Cerebellar Neoplasms ; complications ; diagnosis ; Child ; Child, Preschool ; Facial Muscles ; diagnostic imaging ; pathology ; Female ; Fourth Ventricle ; diagnostic imaging ; pathology ; Hemifacial Spasm ; diagnosis ; etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Radiography

Adult ; Anxiety ; diagnosis ; drug therapy ; psychology ; Botulinum Toxins, Type A ; therapeutic use ; Dystonia ; diagnosis ; drug therapy ; etiology ; Hemifacial Spasm ; diagnosis ; drug therapy ; etiology ; Humans ; Male ; Mastication ; Neuromuscular Agents ; therapeutic use ; Risk Factors

A 61-year-old female presented with 4 years history of left-sided hemifacial spasm. Head MRI and angiography indicated left vertebral artery dissecting aneurysm which compressed ipsilateral cranial nerves Ⅶ and Ⅷ. Microvascular decompression was performed. The dissecting aneurysm was pushed apart and the distal part of the parent artery was adhered to the dura on the petrosum. The compressed nerves were totally decompressed. The symptom of facial spasm was completely resolved immediately after surgery and did not recur during 6 months of follow up.
Cerebral Angiography ; Facial Nerve ; pathology ; Female ; Hemifacial Spasm ; surgery ; Humans ; Magnetic Resonance Imaging ; Microvascular Decompression Surgery ; Middle Aged ; Nerve Compression Syndromes ; diagnosis ; etiology ; surgery ; Vertebral Artery Dissection ; diagnostic imaging ; surgery ; Vestibulocochlear Nerve ; pathology