Prevalence and Associated Factors of Neurovascular Contact in Patients With Hemifacial Spasm
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Abstract:
This study aimed to observe the prevalence and associated factors of neurovascular contact hemifacial spasm (HFS).Keywords:
Neurovascular bundle
Interquartile range
Hemifacial spasm
Univariate analysis
Cross-sectional study
Hemifacial spasm is a common disease however there are some facial movement disorders which have resemblance to hemifacial spasm. Misdiagnosis of hemifacial spasm can mislead to wrong treatment. Hemifacial spasm is characterized by involuntary contractions of muscle groups innervated by ipsilateral facial nerve. The symptoms usually start around the eyes then progressing downward to the cheek, mouth and neck. Its prevalence is 9.8 per 100,000 patients with mean age of onset at 44 – 52 years. The pathophysiology of hemifacial spasm is caused by pathology which compresses the facial nerve at facial nerve root exit zone (FNREZ) such as vessel loops, tumors, etc. Clinical signs, and symptoms together with imaging modalities such as electromyography (EMG), and magnetic resonance imaging (MRI) are useful to differentiate hemifacial spasm from other facial movement disorders and can also identify the pathology for preoperative planning. Botulinum neurotoxin injection is a standard medical management for hemifacial spasm which has low risk but provides limited symptomatic relief. Microvascular decompression (MVD) is the only curative treatment for hemifacial spasm that provides lasting symptomatic relief with low rate of complications because of improvised microsurgical techniques, microneurosurgical instruments and also intraoperative neuromonitoring. Key words: Hemifacial spasm, Treatment, Microvascular decompression โรคใบหนากระตกครงซก และการรกษาดวยการผาตด ปรด นมมานนตย ภาควชาศลยศาสตร คณะแพทยศาสตร มหาวทยาลยธรรมศาสตร บทคดยอ โรคใบหนากระตกครงซก (hemifacial spasm) เปนโรคทพบไดบอยในเวชปฏบตทวไป หากแตยงมโรคอกจำนวนหนงทมอาการคลายคลงกบโรคน ทำใหการวนจฉยทไมถกตอง นำไปสการรกษาทไมถกตอง อาการของโรค hemifacial spasm คอ มการกระตกใบหนาซกเดยว ของกลามเนอทเลยงโดยเสนประสาทสมองคท ๗ (facial nerve) ขางเดยวกน โดยมกจะเรมกระตกบรเวณรอบดวงตา แลวกระจายลงลางไปสกลามเนอบรเวณแกม ปาก และคอ มอบตการณการเกดโรคประมาณ ๙.๘ คนตอประชากร ๑๐๐,๐๐๐ คน และเกดในผปวยอายเฉลยประมาณ ๔๔ - ๕๒ ป สาเหตการเกดโรคนเกดจากการทมพยาธสภาพ เชน หลอดเลอด หรอเนองอก กดทบลงบน facial nerve บรเวณทเพงยนออกมาจากแกนสมอง (facial nerve root exit zone; FNREZ) การวนจฉยแยกโรคนออกจากโรคอน ทมอาการคลายกน ทำไดโดยอาศย อาการ และอาการแสดง รวมกบการตรวจคลนไฟฟากลามเนอ (electromyography; EMG) และเอกซเรยคลนแมเหลกไฟฟาสมอง (magnetic resonance imaging; MRI) จะสามารถบอกถงพยาธสภาพททำใหเกดโรคไดอกดวย การรกษาโรค hemifacial spasm ดวยการฉด botulinum neurotoxin (BoNT injection) ถอเปนวธมาตรฐานของการรกษาโดยการไมผาตดทมความเสยงตำ แตใหผลการรกษาทไมดนก และตองฉดซำทกๆ ๓ - ๖ เดอน การรกษาดวยวธผาตดแยกหลอดเลอดกดทบ ออกจาก FNREZ (microvascular decompression; MVD) เปนการรกษาวธเดยว ทสามารถทำใหผปวยหายขาดจากโรคนได เนองจากเปนการรกษาทตนเหต ทงมผลขางเคยงจากการผาตดตำ เนองจากในปจจบนเทคนคการผาตด เครองมอผาตด และเครองมอตดตามระหวางการผาตดมการพฒนาเปนอยางมาก คำสำคญ: โรคใบหนากระตกครงซก, การรกษา, การผาตดรกษา
Hemifacial spasm
Microvascular Decompression
Facial muscles
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Hemifacial spasm
Neurovascular bundle
Microvascular Decompression
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Objective To investigate the imaging characteristics and etiological diagnosis via the 3.0T magnetic resonance angiography(MRA)in patients with hemifacial spasm.Methods MRA manifestations of 48patients with hemifacial spasm were reviewed retrospectively.The relationship between facial nerves and peripheral vessel were observed to detect offending vessel,and operation results were compared.Results 3D-TOF-MRA showed the responsibility vessel accordance with the surgery results in 46of 48patients(95.8%),and 2cases(4.2%)showed offending vessel of unknown origin.44cases(91.7%)presented neurovascular compression in the root entry zone(REZ),and 1patient was found neurovascular compression in the middle section of 1/3(2%),and 3had lateral 1/3section(6.3%).Neurovascular compression was found in both symptomatic and asymptomatic side in 31patients.The diameter and mesh of blood vessel showed statistical significancy in the symptom of hemifacial spasm(P 0.05).Conclusion MRA discovery of vascular and nerve adjacent may not necessarily produce hemifacial spasm symptoms,only the MRA showed responsible vessel in combination with facial nerve abutting relationship with clinical symptoms can provide important guiding significance for the implementation of microsurgical vascular decompression(MVD).
Hemifacial spasm
Microvascular Decompression
Neurovascular bundle
Magnetic resonance angiography
Etiology
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Objective To investigate the responsibility blood vessel, surgical effect and strategy of the microvascular decompression for hemifacial spasm. Methods The clinical data of 96 patients with hemifacial spasm treated by microvascular decompression were analyzed retrospectively. Results The blood vessels that compressed the facial nerve root-exit-brain stem zone were found in the operation. All the vessels were arteries. Of 96 patients, symptoms were completed remission in 34, significantly reduced in 13, invalid in 2 and recurrenced in 1. Conclusions Microvascular decompression is the most effective method for hemifacial spasm. Skilled microsurgical technique, recognition of the responsibility blood vessel and the deposition of the cotton are the key to the surgery.
Hemifacial spasm
Microvascular Decompression
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Objective: Microvascular decompression (MVD) for hemifacial spasm still presents a challenge regarding postoperative outcome. Insufficient improvement in a certain proportion of patients undergoing MVD for hemifacial spasm is a limitation for this treatment. Therefore, botulinum toxin has emerged as an alternative treatment option. In the present study, the effect of intraoperative EMG-monitoring of lateral spread during MVD for hemifacial spasm on the outcome is presented.
Hemifacial spasm
Microvascular Decompression
Intraoperative neurophysiological monitoring
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Hemifacial spasm
Microvascular Decompression
Arachnoid cyst
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✓ In patients with hemifacial spasm, it has been said that the spasm is due to cross compression of the facial nerve by a blood vessel and that microvascular decompression (MVD) of the facial nerve is an effective treatment. The F waves, which result from backfiring of antidromically activated motor neurons of the facial motor nucleus, are indices of the excitability of the facial motor nucleus and are enhanced in patients with hemifacial spasm. Measuring blink reflexes and abnormal muscle responses (lateral spread), a characteristic sign of hemifacial spasm, has been used to investigate the mechanism of hemifacial spasm pathophysiologically. Thus the authors measured F waves of the facial muscle, blink reflexes, and abnormal muscle responses before and after MVD in patients suffering from hemifacial spasm to investigate the excitability of the facial motor nucleus and the course of the cure of hemifacial spasm after MVD. The authors obtained facial nerve—evoked electromyograms in 20 patients with hemifacial spasm before and after the MVD procedure. On the spasm side, the F waves and blink reflexes were enhanced preoperatively compared to those on the normal side and abnormal muscle responses were recorded in all patients. In 12 patients whose hemifacial spasm had not disappeared completely for 5.1 ± 1.7 (mean ± standard error) months following the MVD procedure, F waves were still enhanced significantly and abnormal muscle responses were still recordable, albeit at lower amplitude. Within 1 month after the hemifacial spasm had disappeared completely, F waves were still significantly enhanced in 17 patients and abnormal muscle responses were recorded in seven of 15 patients. Subsequently, the enhanced F waves and abnormal muscle responses disappeared completely. The authors' study supports the hypothesis that the cause of hemifacial spasm is hyperexcitability of the facial motor nucleus and suggests that additional surgery should not be performed for at least 2 years after MVD, because that period is necessary for the disappearance of the hyperexcitability of the facial motor nucleus.
Hemifacial spasm
Microvascular Decompression
Facial muscles
Orbicularis oculi muscle
Synkinesis
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Objective
To investigate the role of preoperative time of flight magnetic resonance angiography (TOF-MRA) in prognosis of hemifacial spasm after microvascular decompression (MVD).
Methods
One hundred and thirty-six patients with hemifacial spasm, admitted to our hospitals from January 2013 to August 2013, were chosen in our study; 44 were vertebral artery type of hemifacial spasm and 92 were small artery type of hemifacial spasm. These patients accepted MVD operation. Operation time under microscope, operation difficulty degree and post operative recovery degree and rate of cranial neurological dysfunction were retrospectively analyzed between vertebral artery type and small artery type of hemifacial spasm.
Results
The preoperative TOF-MRA image features of two types of hemifacial spasm were similar to the intraoperative findings. Operation time under microscope of vertebral artery type was significantly longer than that of small artery type of hemifacial spasm (P 0.05). The incidence of cranial neurological dysfunction of vertebral arterytype was signficantly higher than that of small artery type (P<0.05).
Conlusion
The preoperative TOF-MRA image features can infer different types of offending vessels and predict surgical difficulty and prognosis.
Key words:
Hemifacial spasm; Microvascular decompression; Offending vessel
Hemifacial spasm
Microvascular Decompression
Magnetic resonance angiography
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Hemifacial spasm
Microvascular Decompression
Univariate analysis
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Hemifacial spasm
Neurovascular bundle
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