Arachnoid bands and venous compression as rare causes of hemifacial spasm: analysis of etiology in 353 patients
- 21 Downloads
Hemifacial spasm is usually caused by arterial compression at the root exit zone of the facial nerve. However, other etiologies have been reported. The aim of this study was to analyze the frequency of other causes of hemifacial spasm.
Our prospectively maintained hemifacial spasm database containing all patients who underwent microvascular decompression (MVD) for hemifacial spasm from 2002 to 2018 was reviewed. All offending structures were identified and recorded by the surgeon at the time of surgery. Additionally, the operative videos were analyzed retrospectively.
MVD was performed in 353 patients. Arterial compression was the main cause of hemifacial spasm in 341 (96.9%) patients. Combined venous-arterial compression was seen in 7 (2.0%) patients. In one patient, the compression was from a large vein. In two patients, no compression was found. One patient who suffered from Bell’s palsy many years previously had severe synkinesis and the other had facial tics. In two patients, the spasm was caused due to strangulation of the facial nerve by arachnoid bands. Long-term follow-up of more than 18 months was available in 249 patients with total resolution or near total resolution of spasms in 89.96% of patients.
In most patients with hemifacial spasm, arterial vessels are involved in compressing the facial nerve. Purely venous compression is rarely encountered. We report for the very first time arachnoid bands strangulating the nerve as a cause for hemifacial spasm without involvement of any vessel.
KeywordsHemifacial spasm Etiology Arachnoid band Microvascular decompression Outcome Endoscope-assisted microsurgery
The authors thank Mr Alistair Jenkins for the revision of the study and Mr. Marc Matthes for the technical assistance.
Compliance with ethical standards
The content of this manuscript has never been presented or published previously.
Conflict of interest
Henry W. S Schroeder is consultant to Karl Storz GmbH & Co. KG, Tuttlingen, Germany. The rest of the authors declare that they have no conflict of interest.
For our prospectively collected database, informed consent was obtained from all individual participants included in the study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 4.Bonde V, Muzumdar D, Goel A (2008) Retroclival arachnoid cyst with hemifacial spasm. Singap Med J 49(10):e281–e282Google Scholar
- 10.El Damaty A, Rosenstengel C, Matthes M, Baldauf J, Dziemba O, Hosemann W, Schroeder HWS (2017) A new score to predict the risk of hearing impairment after microvascular decompression for hemifacial spasm. Neurosurgery. https://doi.org/10.1093/neuros/nyx111
- 11.El Refaee E, Langner S, Baldauf J, Matthes M, Kirsch M, Schroeder HWS (2013) Value of 3-dimensional high-resolution magnetic resonance imaging in detecting the offending vessel in hemifacial spasm: comparison with intraoperative high definition endoscopic visualization. Neurosurgery 73(1):58–67 discussion 67CrossRefGoogle Scholar
- 24.Ogawa H, Hiroshima S, Kamada K (2015) A case of facial spasm associated with ipsilateral cerebellopontine angle arachnoid cyst. Surg J (N Y) 1(1):e38–e40Google Scholar
- 25.Refaee EE, El Refaee E, Rosenstengel C, Baldauf J, Pillich DT, Matthes M, Schroeder HWS (2017) Microvascular decompression for patients with hemifacial spasm associated with common trunk anomaly of the cerebellar arteries—case study and review of literature. Oper Neurosurg 14(2):121–127CrossRefGoogle Scholar