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Surgical treatment of hemifacial spasm with zone-4 offending vessel

  • Clinical Article - Functional
  • Published:
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Abstract

Background

Increasing evidence shows that vascular compression on any of the four zones of facial nerve may cause hemifacial spasms. Vascular compression on zone 4 (the cisternal portion) of the nerve is quite common, but only a very small percentage of such compression will elicit hemifacial spasm, because zone 4 is less susceptible than zone 3 (the root exit zone). Therefore, it seems difficult for the neurosurgeons to distinguish the real culprit vessels in zone 4. Here, our experience in treating vascular compression located in zone 4 of the facial nerve is reported.

Methods

Twelve patients of HFS due to compression of zone 4 were treated with microvascular decompression (MVD) surgery with the aid of combined monitoring of abnormal muscle response (AMR) and Z-L response (ZLR).

Results

All of the 12 patients had a zone 4 compression. In addition, there were vascular compressions on zone 3 (the root exit zone) and/or zone 2 (the attached segment) in six cases. AMR was absent in two cases, unstable in one case, and persisted after vascular decompression in another one case. ZLR was stable before decompression of zone 4 and disappeared after decompression in all cases. After MVD surgery, 11 patients were cured and one patient achieved good resolution of spasm. One patient had postoperative transient tinnitus.

Conclusions

The neurosurgeon should not ignore vascular compression at zone 4, especially when compressions at zones 2 and 3 co-exist. With the aid of AMR and ZLR, we are able to judge whether offending vessels exist at zone 4.

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Authors and Affiliations

  1. Department of Neurosurgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China

    Yi Li, Xuesheng Zheng, Xuming Hua, Tingting Ying, Jun Zhong, Wenchuan Zhang & Shiting Li

  2. The Cranial Nerve Disease Center of Shanghai, Shanghai, China

    Shiting Li

Authors
  1. Yi Li
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  2. Xuesheng Zheng
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  3. Xuming Hua
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  4. Tingting Ying
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  5. Jun Zhong
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  6. Wenchuan Zhang
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  7. Shiting Li
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Corresponding author

Correspondence to Shiting Li.

Additional information

Yi Li and Xuesheng Zheng contributed equally to this study.

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Li, Y., Zheng, X., Hua, X. et al. Surgical treatment of hemifacial spasm with zone-4 offending vessel. Acta Neurochir 155, 849–853 (2013). https://doi.org/10.1007/s00701-013-1623-2

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  • DOI: https://doi.org/10.1007/s00701-013-1623-2

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