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Characteristic anatomical conformation of the vertebral artery causing vascular compression against the root exit zone of the facial nerve in patients with hemifacial spasm

  • Clinical Article - Functional
  • Published:
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Abstract

Background

Hemifacial spasm (HFS) is caused by tortuous offending vessels near the facial nerve root exit zone. However, the definitive mechanism of offending vessel formation remains unclear. We hypothesized that vascular angulation and tortuosity, probably caused by uneven vertebral artery blood flow, result in vascular compression of the facial nerve root exit zone.

Methods

The authors observed two anatomical characteristics of the vertebrobasilar arterial system in 120 subjects in the surgical group and 188 controls. The presence of the dominant vertebral artery (DVA) and laterality of the vertebrobasilar junction (VBJ) were observed. We also analyzed the morphological characteristics of the surgical group showing the presence of DVA. The morphological characteristics were classified into three types: type I had the VBJ and DVA on the same side, type II had the VBJ within 2 mm of the midline, and type III had the VBJ opposite the DVA.

Result

The DVA was more prevalent in the surgical group than in the control group (71 % versus 54 %, P < 0.05). The surgical group patients with HFS on the left were more likely to have a DVA on the left (P < 0.05) and with HFS on the right were more likely to have a DVA on the right (P < 0.01) compared with controls. The direction of the VBJ was more common on the same side as the DVA, which corresponds with the laterality of the HFS. In the surgical group with the DVA and HFS on the same side, type I was predominant, but in the surgical group with a contralateral DVA and HFS, type III was predominant.

Conclusion

The presence of a DVA and shifting of the VBJ on the same side plays a role in the angulation and tortuosity of vessels in the perivertebrobasilar junction, resulting in neurovascular compression of the facial nerve root exit zone and thereby causing HFS.

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Acknowledgments

All authors certify that we have no financial interest in the subject matter discussed in this article.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Research Institute of Clinical Medicine, Chonbuk National University Hospital-Chonbuk National University, Jeonju, Republic of Korea

    Jung-Soo Park, Eun-Jeong Koh, Ha-Young Choi & Jong-Myong Lee

  2. Department of Neurosurgery, Chonbuk National University Medical School/Hospital, 634-18 Geumam-dong, Deokjin-gu, Jeonju, 561-712, Republic of Korea

    Eun-Jeong Koh

Authors
  1. Jung-Soo Park
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  2. Eun-Jeong Koh
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  3. Ha-Young Choi
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  4. Jong-Myong Lee
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Corresponding author

Correspondence to Eun-Jeong Koh.

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Comment

The authors of this interesting article analyze the vertebrobasilar arterial system in 120 patients operated on for hemifacial spasm (HFS) and compare the anatomical findings with a control group of 188 patients. Two variables were analyzed in particular, the dominant vertebral artery (DVA) and the laterality of the vertebrobasilar junction (VBJ). Moreover, they propose a classification of the the DVA-VBJ into type I (same side), type II (2 mm off the midline), and type III (opposite side). The authors postulate that an even blood flow within the vertebrobasilar system leads to significant tortuosity and consequent neurovascular conflict. This is not a completely novel hypothesis; previous authors have demonstrated higher flow rates with a duplex on the side of the neurovascular conflict in patients with HFS. Angiographic analysis of the posterior fossa circulation in patients with HFS has demonstrated significant trunk anomalies; moreover, the anomalies of the main trunk can lead to abnormaly located perforators, which in turn can make mobilization of the vessel difficult. Surgical strategies in these difficult cases can be different from the standard microvascular decompression, and at times sling trasposition at the level of the vertebrobasilar system may be indicated. Still, the reported outcome is quite good with control of the spasm in nearly 80 % of cases. The authors should be congratulated for their effort to anatomically classify vertebrobasilar system abnormalities associated with HFS.

Jibril Osman Farah

Liverpool, UK

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Park, JS., Koh, EJ., Choi, HY. et al. Characteristic anatomical conformation of the vertebral artery causing vascular compression against the root exit zone of the facial nerve in patients with hemifacial spasm. Acta Neurochir 157, 449–454 (2015). https://doi.org/10.1007/s00701-014-2338-8

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  • DOI: https://doi.org/10.1007/s00701-014-2338-8

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