Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
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References
Alemdar M (2012) Epidermoid cyst causing hemifacial spasm epidermoid cyst in cerebellopontine angle presenting with hemifacial spasm. J Neurosci Rural Pract 3(3):344–346
Auger RG, Piepgras DG (1989) Hemifacial spasm associated with epidermoid tumors of the cerebellopontine angle. Neurology 39(4):577–580
Barker FG, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD (1995) Microvascular decompression for hemifacial spasm. J Neurosurg:201–210
Bonde V, Muzumdar D, Goel A (2008) Retroclival arachnoid cyst with hemifacial spasm. Singap Med J 49(10):e281–e282
Campos-Benitez M, Kaufmann AM (2008) Neurovascular compression findings in hemifacial spasm. J Neurosurg 109(3):416–420
Choi S-K, Rhee B-A, Lim YJ (2009) Hemifacial spasm caused by epidermoid tumor at cerebello pontine angle. J Korean Neurosurg Soc 45(3):196–198
Desai K, Nadkarni T, Bhayani R, Goel A (2003) Cerebellopontine angle epidermoid tumor presenting with hemifacial spasms. Neurol India 51(2):288–289
Dumot C, Sindou M (2018) Veins of the cerebellopontine angle and specific complications of sacrifice, with special emphasis on microvascular decompression surgery. A review. World Neurosurg 117:422–432
El Damaty A, Rosenstengel C, Matthes M, Baldauf J, Schroeder HWS (2016) The value of lateral spread response monitoring in predicting the clinical outcome after microvascular decompression in hemifacial spasm: a prospective study on 100 patients. Neurosurg Rev 39(3):455–466
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
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 67
Elgamal EA, Coakham HB (2005) Hemifacial spasm caused by pontine glioma: case report and review of the literature. Neurosurg Rev 28(4):330–332
Han I-B, Chang JH, Chang JW, Huh R, Chung SS (2009) Unusual causes and presentations of hemifacial spasm. Neurosurgery 65(1):130–137
Hertz R, Espinosa J, Lucerna A, Stranges D (2017) Multiple sclerosis presenting with facial twitching (myokymia and hemifacial spasms). Case Rep Neurol Med 2017:7180560
Higashi S, Yamashita J, Yamamoto Y, Izumi K (1992) Hemifacial spasm associated with a cerebellopontine angle arachnoid cyst in a young adult. Surg Neurol 37(4):289–292
Huang CI, Chen IH, Lee LS (1992) Microvascular decompression for hemifacial spasm: analyses of operative findings and results in 310 patients. Neurosurgery 30(1):53–56 discussion 56–7
Liu J, Liu P, Zuo Y, Xu X, Liu H, Du R, Yu Y, Yuan Y (2018) Hemifacial spasm as rare clinical presentation of vestibular schwannomas. World Neurosurg 116:e889–e894
Mastronardi L, Taniguchi R, Caroli M, Crispo F, Ferrante L, Fukushima T (2009) Cerebellopontine angle arachnoid cyst: a case of hemifacial spasm caused by an organic lesion other than neurovascular compression: case report. Neurosurgery 65(6):E1205 discussion E1205
Mercier P, Sindou M (2018) The conflicting vessels in hemifacial spasm: literature review and anatomical-surgical implications. Neurochirurgie 64(2):94–100
Miyazaki S, Fukushima T, Nagai A, Tamagawa T (1987) CP angle meningioma presenting as hemifacial spasm. No Shinkei Geka 15(6):683–686
Møller AR (1999) Vascular compression of cranial nerves: II: pathophysiology. Neurol Res 21(5):439–443
Narayan V, Savardekar AR, Patra DP, Mohammed N, Thakur JD, Riaz M, Nanda A (2018) Safety profile of superior petrosal vein (the vein of Dandy) sacrifice in neurosurgical procedures: a systematic review. Neurosurg Focus 45(1):E3
Nielsen VK (1985) Electrophysiology of the facial nerve in hemifacial spasm: ectopic/ephaptic excitation. Muscle Nerve 8(7):545–555
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–e40
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):121–127
Rosenstengel C, Matthes M, Baldauf J, Fleck S, Schroeder H (2012) Hemifacial spasm: conservative and surgical treatment options. Dtsch Arztebl Int 109(41):667–673
Ruiz-Juretschke F, Vargas A, González-Rodrigalvarez R, Garcia-Leal R (2015) Hemifacial spasm caused by a cerebellopontine angle arachnoid cyst. Case report and literature review. Neurocirugia 26(6):307–310
Samii M, Günther T, Iaconetta G, Muehling M, Vorkapic P, Samii A (2002) Microvascular decompression to treat hemifacial spasm: long-term results for a consecutive series of 143 patients. Neurosurgery 50(4):712–718 discussion 718–9
Sprik C, Wirtschafter JD (1988) Hemifacial spasm due to intracranial tumor. An international survey of botulinum toxin investigators. Ophthalmology 95(8):1042–1045
Takano S, Maruno T, Shirai S, Nose T (1998) Facial spasm and paroxysmal tinnitus associated with an arachnoid cyst of the cerebellopontine angle--case report. Neurol Med Chir 38(2):100–103
Wang A, Jankovic J (1998) Hemifacial spasm: clinical findings and treatment. Muscle Nerve 21(12):1740–1747
Yaltho TC, Jankovic J (2011) The many faces of hemifacial spasm: differential diagnosis of unilateral facial spasms. Mov Disord 26(9):1582–1592
Zhong J, Zhu J, Sun H, Dou N-N, Wang Y-N, Ying T-T, Xia L, Liu M-X, Tao B-B, Li S-T (2014) Microvascular decompression surgery: surgical principles and technical nuances based on 4000 cases. Neurol Res 36(10):882–893
Acknowledgments
The authors thank Mr Alistair Jenkins for the revision of the study and Mr. Marc Matthes for the technical assistance.
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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.
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For our prospectively collected database, informed consent was obtained from all individual participants included in the study.
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This article is part of the Topical Collection on Functional Neurosurgery - Movement disorders
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El Refaee, E., Marx, S., Rosenstengel, C. et al. Arachnoid bands and venous compression as rare causes of hemifacial spasm: analysis of etiology in 353 patients. Acta Neurochir 162, 211–219 (2020). https://doi.org/10.1007/s00701-019-04119-5
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DOI: https://doi.org/10.1007/s00701-019-04119-5