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

The authors present a case of isolated dural arteriovenous fistula (DAVF) in the transverse sinus, which developed six years after microvascular decompression caused by hemifacial spasm via suboccipital craniectomy. The lesion was successfully treated by transarterial embolization using Onyx. We reviewed the related radiologic and therapeutic features of DAVF involving an isolated sinus and described the feasibility of the use of Onyx.
Central Nervous System Vascular Malformations ; Hemifacial Spasm ; Microvascular Decompression Surgery

The result of microvascular decompression(MVD) in 105 consecutive cases is presented. The symptomatic vasculoneural compressions including tumor, vascular malformation, or aneurysm are excluded in this study group. The 41 patients with trigeminal neuralgia(TN) were all treated by posterior fossa exploration(PEE). Eighteen of them were treated with MVD only, another 14 with partial sensory rhizotomy(PSR) only, and in the other 9 patients, MVD and PSR were performed together. Sixty-twp of 64 hemifacial spasm(HFS) cases were treated succesfully with MVD via PFE. However in one case of which the offending vessel was not identified, neurolysis was carried out. The other case who had both TN and HFS, died due to intraoperative cardiac arrest. The result of operation was evaluated at one month after the operation. In TN, among thirty-nine(98%) patients who resulted in pain-improvement, 32(82%) experienced complete resolution of the pain, The rate complete pain-relief was higher in the 'MVD only group' than in 'group with PSR'. Among 62(94%) cases of HFS, 29(47%) patients obtained 'complete cure' and 'improvement-only' respectively ; only 4(6%) patients had no change of the spasm. The preoperative clinical characteristics, intraoperative surgical findings and postoperative outcomes were itemized and analyzed find out the prognostic factors. The our results are compared with others in the literature.
Aneurysm ; Decompression* ; Heart Arrest ; Hemifacial Spasm* ; Humans ; Microvascular Decompression Surgery ; Spasm ; Trigeminal Neuralgia* ; Vascular Malformations

OBJECTIVE: This study is to investigate time course of symptom disappearance in patients whose spasm relieved completely after microvascular decompression (MVD). METHODS: Of 115 patients with hemifacial spasm (HFS) who underwent MVD from April 2003 to December 2006, 89 patients who had no facial paralysis after operation and showed no spasm at last follow-up more than 1.5 years after operation were selected. Symptom disappearance with time after MVD was classified into type 1 (symptom disappearance right after operation), type 2 (delayed symptom disappearance) and type 3 (unusual symptom disappearance). Type 2 was classified into type 2a (with postoperative silent period) and type 2b (without silent period). RESULTS: Type 1, type 2a, type 2b and type 3 were 38.2%, 48.37%, 12.4% and 1.1%, respectively. Delayed disappearance group (type 2) was 60.7%. Post-operative symptom duration in all cases ranged from 0 to 900 days, average was 74.6 days and median was 14 days. In case of type 2, average post-operative symptom duration was 115.1 days and median was 42 days. Five and 3 patients required more than 1 year and 2 years, respectively, until complete disappearance of spasm. In type 2a, postoperative silent period ranged from 1 to 10 days, with an average of 2.4 days. CONCLUSION: Surgeons should be aware that delayed symptom disappearance after MVD for HFS is more common than it has been reported, silent period can be as long as 10 days and time course of symptom disappearance is various as well as unpredictable.
Facial Paralysis ; Follow-Up Studies ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery ; Spasm

Hemifacial Spasm/surgery* ; Humans ; Microvascular Decompression Surgery ; Philosophy ; Postoperative Complications ; Treatment Outcome

Hemifacial spasm is painless uncommon disorder characterized by involuntary paroxysmal movement of one side of face. Microvascular decompression at root exit zone of the facial nerve has become the standard treatment for hemifacial spasm. An alternative hypothesis, proposed for the relieve of hemifacial spasm with microvascular decompression, actually result from minor trauma or circumferential fibrosis to a sensitive zone of the facial nerve. Upon the base of this hypothesis, author have treated patient with hemifacial spasm with surgical manipulation in addition to microvascular decompression. During last fifteen years, 250 patients with hemifacial spasm underwent this operation. The age at operation ranged from 18 to 71 years, with mean over 45.7 years and the duration of symptoms averaged 5.8 years. The spasms occurred predominantly right side, 5 cases were bilateral. The common offending vessels were AICA in 127 cases(50.8%) and PICA in 50 cases(20%). The remainder were 17 cases in vertebral artery, 9 cases in labyrin-thine artery(3.6%) and multiple offending vessels were found in 29 cases(11.6%). In two hundred fifteen cases, the spasm was completely relieved within 5 days after operation. Among 25 cases whose spasm unrelieved initially after surgery, 19 cases was relieved within 3 weeks and 6 cases within 3 months. Complications following surgery is approximately 22.8%: the most commonly encountered deficit is facial weakness(16 cases) followed by CSF leak (12 cases), and some degree of hearing loss(12 cases). Other complications include wound infection, ataxia, pneumocephalus and focal hemorrhage. Surgical manipulation in addition to microvascular decompression for hemifacial spasm(a new combined approach) produces better results of improvement approximately up to 96%.
Ataxia ; Facial Nerve ; Fibrosis ; Hearing ; Hemifacial Spasm* ; Hemorrhage ; Humans ; Microsurgery* ; Microvascular Decompression Surgery ; Pica ; Pneumocephalus ; Spasm ; Vertebral Artery ; Wound Infection

Hemifacial spasm consists of irregular, but repetitive clonic twitching of the muscles of one side of the face. Usually it is first involved around the eyes, the repetitive twitching spreads slowly to involve the whole face. It most commonly affects middle aged or elderly women, and usually appears with an aberrant vascular cross-compression near the root entry zone (REZ) of VII nerve. Among numerous approaches to treat facial spasm, only Jannetta's microvascular decompression has confirmed efficacy. However facial nerve block by needle insertion technique seems to be of benefit in patients with mild spasm, the elderly, poor risks and those who refuse the craniotomy. To treat our three patients with hemifacial spasm, we did physical facial nerve block by a direct puncture of the facial nerve trunk just at its exit from the stylomastoid foramen. Satisfactory results were obtained by the treatment employed. This technique is a valuable method in the treatment of hemifacial spasm.
Aged ; Craniotomy ; Facial Nerve* ; Female ; Hemifacial Spasm* ; Humans ; Microvascular Decompression Surgery ; Middle Aged ; Muscles ; Needles ; Punctures ; Spasm

OBJECTIVE: Microvascular decompression(MVD) at root exit zone(REZ) of the facial nerve has been largely popularized and it has become the standard treatment for patients with hemifacial spasm(HFS). This sturdy is performed to evaluate the efficacy of MVD over the course of time. METHODS: From 1994 to 2003, 50 patients with HFS who underwent MVD were followed up for more than 6 months. We retrospectively analyzed results with medical records and telephone researches. RESULTS: The mean age of patients at the time operation was 57.6 years and 84% of the patients were female. The mean duration of follow-up after operation was 3.4 years (range 0.5~7.8 years). One day after MVD, 54% of patients had complete relief of spasm immediately. Continuous improvements of HFS were observed during the follow-up period and these improvements were statistically significant with time (P<0.05). Until 6 months after operation, complete relief of spasm was observed in 84% of patients. The delayed relief of spasm was observed in 35.7% of our patients who experienced complete relief. CONCLUSION: The efficacy of MVD in HFS is improves with time. Continuous follow-up evaluations for the duration of more than at least 6 months after MVD are important for the decision of its clinical results because delayed relief of spasms occurs.
Facial Nerve ; Female ; Follow-Up Studies ; Hemifacial Spasm* ; Humans ; Medical Records ; Microvascular Decompression Surgery* ; Retrospective Studies ; Spasm ; Telephone

OBJECTIVE: The purpose of this study was to evaluate the characteristics and surgical outcomes of familial hemifacial spasm (HFS) and to discuss the role of genetic susceptibility. METHODS: Between 2001 and 2011, 20 familial HFS patients with ten different pedigrees visited our hospital. The data from comprehensive evaluation of these patients, including clinical, radiological and electrophysiological data and surgical outcomes were reviewed to characterize familial HFS and to compare the characteristics between familial HFS and sporadic HFS. RESULTS: According to the family tree, the inheritance pattern was difficult to define clearly using these data. Radiologic findings suggested that the vertebral artery (VA) was a more frequent offender in familial HFS than in sporadic cases (35.0% vs. 10.0%, p<0.001). Chi-square test showed that there were no correlation between VA tortuosity and underlying morbidity such as diabetes or hypertension (p=0.391). Eighteen out of 19 patients who underwent microvascular decompression showed no residual spasm. Other features of familial HFS overlap with sporadic cases. These findings suggest that certain genetic susceptibilities rather than hypertension or diabetes may influence vascular tortuosity and HFS development. CONCLUSION: In this study, familial HFS seems not so different from sporadic cases. Authors thought familial HFS could have heterogeneous etiology. Further study of familial HFS including clinical, anatomic, genetic, and molecular information may help identify a gene or trait that can provide insight into the mechanisms of sporadic and familial HFS.
Criminals ; Genes, vif ; Genetic Predisposition to Disease ; Hemifacial Spasm ; Humans ; Hypertension ; Inheritance Patterns ; Microvascular Decompression Surgery ; Pedigree ; Spasm ; Vertebral Artery

Hemifacial spasm is a relatively uncommon but distressing condition characterized by insiduous development of paroxysmal, involuntary, unilateral hyperkinetic facial movement. In patients with hemifacial spasm, there is an abnormality in the facial nerve or its nucleus which allows the stimulus applied to one branch of the facial nerve to spread to other branches of that same nerve. This lateral spread response is presumed to be due to cross transmission of the antidromic activity in the branch of the facial nerve, and intraoperative monitoring of lateral spread responses provides a useful way of confirming complete facial nerve decompression. In 17 consecutive patients, intraoperative electromyographic(EMG) recordings were made from facial muscles during microvascular decompression for hemifacial spasm. At the beginning of the operation, electrical stimulation of the temporal or zygomatic branch of the facial nerve gave rise to electrically recordable activity in the mentalis muscle(lateral spread), with a latency of about 10msec, that in ten patients, lasted until the facial nerve was decompressed; In seven patients, however, it disappeared when the arachnoid membrane was opened. Early disappearance of lateral spread was frequently occurred in single offending vessel or cases where there was loose compression. Postsurgically the 16 patients in whom the lateral spread response disappeared totally were free from spasm after the operation and in the remaining patient, there was much improvement. These results support the use of lateral spread response monitoring during decompression surgery for hemifacial spasm, and provide strong circumstantial evidence that vascular cross-compression is an important etiologic factor in hemifacial spasm. During a decompression operation for hemifacial spasm, the authors now routinely monitor facial EMG response.
Arachnoid ; Decompression* ; Electric Stimulation ; Facial Muscles ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Membranes ; Microvascular Decompression Surgery ; Monitoring, Intraoperative ; Spasm