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Poonyathalang A, Tiraset N, Rattanathamsakul N. Effectiveness of 0.3% Hyaluronic Acid Eye Drops for Benign Essential Blepharospasm and Hemifacial Spasm with Botulinum Toxin-induced Dry Eye. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6050. [PMID: 39139840 PMCID: PMC11321754 DOI: 10.1097/gox.0000000000006050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 06/21/2024] [Indexed: 08/15/2024]
Abstract
Background This study evaluates the effectiveness of 0.3% hyaluronic acid (HA) eye drops in patients receiving concurrent botulinum toxin (BoNT) injections for benign essential blepharospasm (BEB) or hemifacial spasm (HFS). Methods This randomized controlled cross-over trial study involved 14 patients with BEB and 33 patients with HFS randomized into two groups (early treatment and deferred treatment) for 3 months of treatment with 0.3% HA eye drops. Data collected at baseline, 3 months, and 6 months included Blepharospasm Severity Scale (BSS) score in patients with BEB; Samsung Medical Class Grading Scale score in patients with HFS; and dry eye symptoms, lower eyelid tear meniscus height (TMH), tear breakup time (TBUT), and corneal fluorescein staining in both groups. Results After 3 months of 0.3% HA instillation, patients with BEB in both groups showed significant improvement in BSS, TMH, TBUT, and the amelioration of subjective dry eye symptoms and corneal staining (P < 0.05). However, discontinuation of 0.3% HA eye drops worsened BSS, TMH, and TBUT. Patients with HFS also experienced significant improvement in Samsung Medical Class score, subjective dry eye symptoms, and objective corneal findings (P < 0.05). Conclusions Treatment with 0.3% HA eye drops led to significant improvement in spasm severity, and dry eye parameters, after 3 months of instillation in patients with BEB or HFS during concurrent treatment with BoNT injections. The 0.3% HA eye drops were safe and might serve as an add-on treatment for symptom improvement.
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Affiliation(s)
- Anuchit Poonyathalang
- From the Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nanida Tiraset
- From the Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Natthapon Rattanathamsakul
- From the Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Anudeep DDS, Karthik K, Holla VV, Kamble N, Yadav R, Pal PK, Mahale RR. Ventrolateral medullary compression by vascular contact in primary hemifacial spasm: a radiological analysis. Neurol Sci 2024:10.1007/s10072-024-07602-9. [PMID: 38789836 DOI: 10.1007/s10072-024-07602-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The neurovascular conflict (NVC) causing hemifacial spasm (HFS) can also cause compression of ventrolateral medulla (VLM) which contains the central sympathetic neurons. VLM compression has been associated with hypertension. Whether the VLM compression in HFS patients is associated with hypertension is not clear. OBJECTIVE To determine the frequency, severity of VLM compression and its association with hypertension in HFS patients. METHODS A cross-sectional, hospital-based, case control study and recruited 120 study subjects (50 cases of primary HFS, 30 hypertensive and 40 normotensive age-, sex- matched controls). The VLM compression was assessed in magnetic resonance imaging Constructive Interference in Steady State (CISS) 3D sequences. RESULTS Hypertension was present in 30 cases (60%). Six patients with HFS (20%) were detected to be hypertensive after the onset of HFS. VLM compression was seen in 24 cases (48%), 7 hypertensive controls (23.3%) and 5 normotensive controls (10%) (p = 0.03). Twenty-four patients with hypertension had VLM compression and remaining 6 patients with hypertension did not have VLM compression (80% vs 20%; p = 0.02). Normotensive patients did not have VLM compression. Vertebral artery was the most common artery causing VLM compression (22 patients; 7 hypertensive and 5 normotensive controls). CONCLUSION VLM compression is more common in HFS patients as compared to hypertensive and normotensive controls. It is more common in hypertensive HFS patients in comparison with normotensive HFS patients. Microvascular decompression is an option in hypertensive HFS patients with VLM compression if the hypertension is medically refractory.
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Affiliation(s)
- D D S Anudeep
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - K Karthik
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Rohan R Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences, First Floor, Neurosciences Faculty Block, Hosur Road, Bangalore, 560029, Karnataka, India.
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Siddiqi I, Brazdzionis J, Hough JM, Reier L, Marino M, Ko K, Schiraldi M, Cortez V, Miulli DE. Evaluating Changes in Pulsatile Flow With Endovascular Stents in an In Vitro Blood Vessel Model: Potential Implications for the Future Management of Neurovascular Compression Syndromes. Cureus 2024; 16:e59811. [PMID: 38846216 PMCID: PMC11155711 DOI: 10.7759/cureus.59811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Neurovascular compression syndromes (NVCS), encompassing conditions such as trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia, significantly impair patient quality of life through abnormal vascular compression and micro-pulsation of vasculature on cranial nerves at the Obersteiner-Redlich zone. The modulation of pulsatile flow dynamics via endovascular stents presents a novel research frontier for alleviating these syndromes. AIM The primary aim of this investigation was to delineate the impact of various endovascular stents on pulsatile flow within an in vitro model of a blood vessel, thereby elucidating their potential applicability in the therapeutic management of NVCS. MATERIALS AND METHODS A simple in vitro analog of a posterior circulation artery was developed, employing an intravenous pump to replicate cardiac-induced blood flow. Within this model, alterations in pulsatile flow were quantitatively assessed following the introduction of three categorically distinct endovascular stents, varying in size. This assessment was facilitated through the employment of both micro-Doppler and Doppler ultrasound methodologies. RESULTS The Pipeline 5x35 mm stent (Medtronic, Minneapolis, MN) demonstrated the most significant reductions in peak systolic velocity (Vmax) and pulsatility index (PI), PI especially over the stent, suggesting its potential for drastically altering blood flow dynamics. Similarly, Neuroform Atlas 4.5x30 mm and Neuroform Atlas 4x24 mm stents (Stryker, Kalamazoo, MI) also showed notable decreases in hemodynamic parameters, albeit to different extents. Statistical analysis confirmed that these changes were significantly different from the control (P < 0.0001 for PI and Vmax; P < 0.05 for inter-stent comparisons), except for proximal PI means, which did not significantly differ from the control (P = 0.2777). CONCLUSION These findings affirm the potential of endovascular stents to substantially modulate arterial pulsatility. The observed decrease in pulsatile flow resultant from endovascular stent application has the potential to attenuate ectopic nerve excitation, a hallmark of NVCS. Consequently, this research highlights the prospective utility of endovascular stents in developing minimally invasive therapeutic approaches for NVCS.
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Affiliation(s)
- Imran Siddiqi
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James Brazdzionis
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Jordan M Hough
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | - Louis Reier
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | - Maxwell Marino
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Katherine Ko
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | | | - Vladimir Cortez
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | - Dan E Miulli
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
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Al-Mutawa M, Schroeder HWS. Arachnoid bands in hemifacial spasm: an overlooked etiology? Illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE24164. [PMID: 38621308 PMCID: PMC11023010 DOI: 10.3171/case24164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Primary hemifacial spasm (HFS) is usually caused by arterial compression of the facial nerve at the root exit zone at the brainstem. Rarely, a purely venous compression is seen. However, arachnoid bands strangulating the facial nerve have not been recognized as a cause of hemifacial spasm. OBSERVATIONS The authors present a case of a 24-year-old female who had experienced HFS for 9 years. Endoscopic inspection of the root exit zone revealed no vascular compression but an arachnoid band strangulating the facial nerve. After cutting the band, the lateral spread response disappeared, and the patient was immediately spasm free after the surgery. Two years later, she was still doing well without any spasms. LESSONS This is the third patient in the authors' series of 535 patients who had no vascular conflict but rather a strangulation of the nerve by arachnoid bands. All patients have remained spasm free. To the authors' knowledge, no other group has reported arachnoid bands as an etiological factor of HFS so far.
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Kościołek D, Kobierecki M, Tokarski M, Szalbot K, Kościołek A, Malicki M, Wanibuchi S, Wiśniewski K, Piotrowski M, Bobeff EJ, Szmyd BM, Jaskólski DJ. The Anterior Inferior Cerebral Artery Variability in the Context of Neurovascular Compression Syndromes: A Narrative Review. Biomedicines 2024; 12:452. [PMID: 38398054 PMCID: PMC10887044 DOI: 10.3390/biomedicines12020452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
The anterior inferior cerebellar artery (AICA) is situated within the posterior cranial fossa and typically arises from the basilar artery, usually at the pontomedullary junction. AICA is implicated in various clinical conditions, encompassing the development of aneurysms, thrombus formation, and the manifestation of lateral pontine syndrome. Furthermore, owing to its close proximity to cranial nerves within the middle cerebellopontine angle, AICA's pulsatile compression at the root entry/exit zone of cranial nerves may give rise to specific neurovascular compression syndromes (NVCs), including hemifacial spasm (HFS) and geniculate neuralgia concurrent with HFS. In this narrative review, we undertake an examination of the influence of anatomical variations in AICA on the occurrence of NVCs. Significant methodological disparities between cadaveric and radiological studies (CTA, MRA, and DSA) were found, particularly in diagnosing AICA's absence, which was more common in radiological studies (up to 36.1%) compared to cadaver studies (less than 5%). Other observed variations included atypical origins from the vertebral artery and basilar-vertebral junction, as well as the AICA-and-PICA common trunk. Single cases of arterial triplication or fenestration have also been documented. Specifically, in relation to HFS, AICA variants that compress the facial nerve at its root entry/exit zone include parabola-shaped loops, dominant segments proximal to the REZ, and anchor-shaped bifurcations impacting the nerve's cisternal portion.
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Affiliation(s)
- Dawid Kościołek
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mateusz Kobierecki
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mikołaj Tokarski
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Konrad Szalbot
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Aleksandra Kościołek
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Mikołaj Malicki
- Medical Faculty, Medical University of Lodz, Kosciuszki St., 90-419 Lodz, Poland; (D.K.); (M.K.); (M.T.); (K.S.); (A.K.); (M.M.)
| | - Sora Wanibuchi
- The Faculty of Medicine, Aichi Medical University, Nagakute 480-1195, Japan;
| | - Karol Wiśniewski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
| | - Michał Piotrowski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
| | - Ernest J. Bobeff
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowieka St. 6/8, 92-251 Lodz, Poland
| | - Bartosz M. Szmyd
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Sporna St. 36/50, 91-738 Lodz, Poland
| | - Dariusz J. Jaskólski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (M.P.); (E.J.B.); (D.J.J.)
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Aktan D, Depierreux F. How to face the hemifacial spasm: challenges and misconceptions. Acta Neurol Belg 2024; 124:17-23. [PMID: 37498482 DOI: 10.1007/s13760-023-02342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
Hemifacial spasm (HFS) is characterised by intermittent, brief or sustained, repetitive contractions of the muscles innervated by one facial nerve. It is one of the most frequent movement disorders affecting the face. However common and allegedly straightforward to diagnose, it might reveal as a challenge for clinicians in various situations. Indeed, it often needs prior exclusion of many other movement disorders affecting the face, with frequent phenomenological overlaps with blepharospasm, post-facial palsy, facial motor tics, etc. The clinical diagnosis shall be supported by modern brain imaging techniques, and sometimes electromyography, as some particular aetiologies may require specific treatment. Primary forms are associated with vascular compression of the ipsilateral seventh cranial nerve, whereas secondary forms can be caused by any injury occurring on the facial nerve course. This article proposes a global and organised approach to the diagnosis, and the ensuing therapeutic options, as many practitioners still use some inefficient medications when they encounter a case of facial spasm.
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Affiliation(s)
- David Aktan
- Neurology Department, University Hospital of Liège, CHU Liege, Avenue Hippocrate-B35, 4000, Liège, Belgium.
| | - Frédérique Depierreux
- Neurology Department, University Hospital of Liège, CHU Liege, Avenue Hippocrate-B35, 4000, Liège, Belgium
- Movement Disorder Unit, Neurology Department, CHU Liège, Liège, Belgium
- GIGA-CRC in vivo imaging, University of Liège, Liège, Belgium
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Nunta-Aree S, Kateyoi T, Sitthinamsuwan B. Delayed complete remission of hemifacial spasms following microvascular decompression and the implications for optimal time of revision surgery. Acta Neurochir (Wien) 2024; 166:12. [PMID: 38227077 DOI: 10.1007/s00701-024-05891-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Microvascular decompression (MVD) is an effective method for directly treating hemifacial spasms (HFS). The timing for the consideration of failed MVD and reoperation has been paradoxical. OBJECTIVE This study aimed to investigate the delayed complete remission of HFS in terms of prevalence rate, duration between surgery and delayed complete remission, and predictive factors. METHODS A hundred patients with HFS who underwent MVD from 2012-2021 were enrolled in the study. All HFS occurred as a result of compression of the facial nerve by adjacent blood vessels. Clinical information, intraoperative findings, and surgical outcomes were incorporated for data analysis. RESULTS In the first week after MVD, 67 of 100 patients achieved complete remission of HFS, while the remaining 33 had incomplete remission. In long-term follow-up, 26 individuals gradually developed delayed complete remission with a median duration of 9.1 months. Finally, 86 of 100 patients achieved complete long-term remission. Recurrent HFS and incomplete remission were found in 7 and 7 patients, respectively. Factors associated with postoperative complete remission in the first week were a severe degree of facial nerve compression (p = 0.047, OR 2.75, 95% CI 1.01-7.40), with long-term complete remission was left-sided HFS (p = 0.012, OR 5.73, 95% CI 1.47-22.36), and with the appearance of delayed complete remission was the prolonged duration of HFS at least 3 years before MVD (p = 0.046, OR 3.75, 95% CI 1.03-13.76). Transient facial paresis was found in 11% of the patients. Of them, facial nerve function recovered completely in all cases. CONCLUSIONS A delayed complete remission of HFS could be expected in long-term follow-up after MVD and is probably related to a longer duration of HFS before surgery. Unnecessary reoperation should be avoided in the early years following the first surgery.
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Affiliation(s)
- Sarun Nunta-Aree
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Thanthip Kateyoi
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
- Department of Surgery, Prajuabkirikhan Hospital, Prajuabkirikhan, Thailand
| | - Bunpot Sitthinamsuwan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand.
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Maytharakcheep S, Phokaewvarangkul O, Bhidayasiri R. Does needle size matter? Effects of micro-hypodermic needle injections of botulinum toxin type A in patients with hemifacial spasm. Parkinsonism Relat Disord 2024; 118:105950. [PMID: 38081119 DOI: 10.1016/j.parkreldis.2023.105950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Botulinum toxin type A (BoNT/A) injections are the first-line treatment for primary hemifacial spasms (HFS), but require frequent painful injections. Although micro-hypodermic needles are commonly used for aesthetic BoNT/A injections to lessen pain and bruising, their benefits in HFS remain unclear. OBJECTIVE To compare side effects of BoNT/A injection, specifically pain and bruising, between primary HFS patients who received injections using micro-hypodermic needles (34-G) and those using standard needles (30-G). METHODS This cross-over, double-blind, randomised controlled trial involved HFS patients who received BoNT/A injections using either a 34-G or 30-G needle at two visits 12 weeks apart. Primary outcomes, pain and bruising were assessed immediately after injection using the Visual Analogue Scale (VAS) and Short-form McGill Pain Questionnaire (Thai version, SF-MPQ). Bruise assessment was also conducted one week after each injection. Secondary outcomes involved comparing efficacy of BoNT/A between the two types of needles and assessing other complications beyond pain and bruising. RESULTS 65 HFS patients (47 women and 18 men; mean age 59.46 ± 11.48 years; mean disease duration 5.86 ± 4.16 years) were included in the study. Patients who received 34-G needle injections reported significantly reduced pain, as indicated by VAS, total SF-MPQ scores, and bruise scores, compared to those who received 30-G needle injections (p < 0.001, each). There were no differences in efficacy or occurrence of other complications associated with BoNT/A between the two needle types. CONCLUSION In HFS patients, BoNT/A injections using micro-hypodermic needles resulted in reduced pain and bruising, compared to standard needles, while maintaining similar BoNT/A benefits.
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Affiliation(s)
- Suppata Maytharakcheep
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand.
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Rubio AS, Rodríguez-Rubio HA, López-Rodríguez R, Bonilla-Suastegui A, Piñón-Jiménez F, Contreras-Vázquez OR, Revuelta-Gutiérrez R. Microvascular decompression for hemifacial spasm: Complications after 292 procedures without neurophysiological monitoring. Surg Neurol Int 2023; 14:343. [PMID: 37810311 PMCID: PMC10559543 DOI: 10.25259/sni_578_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Background Hemifacial spasm (HFS) is characterized by involuntary, progressive, and intermittent spasms in the upper and lower facial muscles. Due to the high success rate, microvascular decompression (MVD) is the treatment of choice, and intraoperative neuromonitoring (INM) is considered useful for achieving safe surgery. Still, most centers do not have this technology. Methods We analyzed 294 patients with HFS treated with MVD without INM. We only included patients with a neurovascular etiology while excluding other causes, such as tumors. As part of the postoperative evaluation, we assessed preoperative magnetic resonance imaging and pure-tone audiometry. Results The main complication was peripheral facial paralysis in 50 patients, followed by hypoacusis in 22 patients and deafness in 17 patients, associated with a failed surgical outcome (P = 0.0002). The anterior inferior cerebellar artery (AICA) was an offending vessel, and the involvement of more than one vessel was significantly associated with the development of facial nerve palsy (P = 0.01). AICA was also associated with hearing impairment (P = 0.04). Over 90% of immediate complications improve in the follow-up (6 months), and one patient did not show a cure for initial HFS. Conclusion MVD is the method with the highest long-term cure rates for treating HFS; however, we must inquire into the multiple factors of the patient and the surgeon to predict surgical outcomes. INM is not a must during MVD for HFS. We recommend its use depending on the availability and mainly on the surgeon's skills, for surgeons.
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Affiliation(s)
| | | | | | | | | | | | - R. Revuelta-Gutiérrez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Malicki M, Szmyd BM, Bobeff EJ, Karuga FF, Piotrowski MM, Kościołek D, Wanibuchi S, Radek M, Jaskólski DJ. The Superior Cerebellar Artery: Variability and Clinical Significance. Biomedicines 2023; 11:2009. [PMID: 37509648 PMCID: PMC10376954 DOI: 10.3390/biomedicines11072009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The superior cerebellar artery (SCA) arises from the distal part of the basilar artery and passes by the oculomotor, trochlear, and trigeminal nerves. SCA is known to play a crucial role in the development of trigeminal neuralgia. However, due to its anatomical variability, it may also trigger other neurovascular compression (NVC), including hemifacial spasm, oculomotor nerve palsy, and ocular neuromyotonia. Additionally, it may be associated with ischemic syndromes and aneurysm development, highlighting its clinical significance. The most common anatomical variations of the SCA include duplication, a single vessel origin from the posterior cerebral artery (PCA), and a common trunk with PCA. Rarely observed variants include bifurcation and origin from the internal carotid artery. Certain anatomical variants such as early bifurcation and caudal course of duplicated SCA trunk may increase the risk of NVC. In this narrative review, we aimed to examine the impact of the anatomical variations of SCA on the NVCs based on papers published in Pubmed, Scopus, and Web of Science databases with a snowballing approach. Our review emphasizes the importance of a thorough understanding of the anatomical variability of SCA to optimize the management of patients with NVCs associated with this artery.
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Affiliation(s)
- Mikołaj Malicki
- Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, Zeromskiego St. 113, 90-549 Lodz, Poland; (M.M.); (M.R.)
| | - Bartosz M. Szmyd
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (B.M.S.); (M.M.P.); (D.J.J.)
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Sporna St. 36/50, 91-738 Lodz, Poland
| | - Ernest J. Bobeff
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (B.M.S.); (M.M.P.); (D.J.J.)
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowieka St. 6/8, 92-251 Lodz, Poland;
| | - Filip F. Karuga
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowieka St. 6/8, 92-251 Lodz, Poland;
| | - Michał M. Piotrowski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (B.M.S.); (M.M.P.); (D.J.J.)
| | - Dawid Kościołek
- Central Teaching Hospital, Medical University of Lodz, Pomorska St. 251, 92-208 Lodz, Poland;
| | - Sora Wanibuchi
- The Faculty of Medicine, Aichi Medical University, Nagakute 480-1195, Japan;
| | - Maciej Radek
- Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, Zeromskiego St. 113, 90-549 Lodz, Poland; (M.M.); (M.R.)
| | - Dariusz J. Jaskólski
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego St. 22, 90-153 Lodz, Poland; (B.M.S.); (M.M.P.); (D.J.J.)
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11
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Shimansky VN, Ogurtsova AA, Poshataev VK, Shevchenko KV, Tanyashin SV, Rybakov VA. [Early results of intraoperative neurophysiological monitoring in surgical treatment of hemifacial spasm]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:56-64. [PMID: 37325827 DOI: 10.17116/neiro20238703156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Neurophysiological monitoring in surgery for hemifacial spasm has been used since the 1990s, when Moller et al. demonstrated the effectiveness of intraoperative assessment of lateral spread response (LSR) regarding postoperative outcomes. Currently, there are conflicting data on effectiveness and feasibility of this technique. Widespread hemifacial spasm determines the relevance of neurophysiological monitoring in surgical treatment of these patients. OBJECTIVE To evaluate the effectiveness of various methods of intraoperative neurophysiological monitoring in surgical treatment of hemifacial spasm regarding early postoperative outcomes. MATERIAL AND METHODS The study group included 43 patients (8 men and 35 women) aged 26-68 years. We assessed severity of hemifacial spasm using the SMC Grading Scale. All patients underwent vascular decompression of the facial nerve under neurophysiological control: monitoring of transcranial motor evoked potentials from facial muscles (m. orbicularis oculi, m. orbicularis oris, m. mentalis) and recording unilateral LSR. The control group included 23 patients (4 men and 19 women) aged 29-83 years. In this group, facial nerve decompression was performed without neurophysiological control. The effect of neurophysiological monitoring on postoperative outcomes (in-hospital period and 3 postoperative months) after vascular decompression of the facial nerve was assessed using the SMC Grading Scale. We considered severity and incidence of spasms. RESULTS Thirty-one (72%) patients in the main group had no spasms of mimic muscles at discharge. In the control group, there were no spasms in 15 patients (65%). At the same time, there were fewer Grade I patients in the control group (12%) compared to the main group (26%). Moreover, 27 (66%) and 12 (52%) patients were free from episodes of hemifacial spasm in both groups, respectively. Patients with hemifacial spasm grade I-II comprised 29% in the main group and 34% in the control group. The number of relapses within three months increased in the control group (13%). CONCLUSION Intraoperative monitoring of transcranial motor evoked potentials from the facial muscles and LSR during vascular decompression of the facial nerve increases the efficiency of surgery for hemifacial spasm in early postoperative period. Less number of relapses and lower intensity of hemifacial spasm necessitate neurophysiological monitoring in neurosurgical treatment of these patients.
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Affiliation(s)
| | | | | | | | | | - V A Rybakov
- Burdenko Neurosurgical Center, Moscow, Russia
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12
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Otomo M, Inoue T, Ezura M, Uenohara H, Tominaga T. Degeneration of Urethane Sponge Prosthesis as Source of Late Recurrence of Hemifacial Spasm: A Case Report. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Eyigürbüz T, Yıldırım Z, Korkut E, Akalın Akkaş E, Adatepe MT, Kale N. Neuroimaging Findings in Hemifacial Spasm: A Single-Center Experience. ISTANBUL MEDICAL JOURNAL 2022. [DOI: 10.4274/imj.galenos.2022.44520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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14
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Hunsaker JC, Baker CM, Schmidt RH, Rahimpour S. Hemifacial spasm secondary to Chiari malformation type I: Systematic review with case illustration. J Clin Neurosci 2022; 101:21-25. [DOI: 10.1016/j.jocn.2022.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
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15
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Valente Aguiar P, Silveira F, Vaz R, Linhares P, Pereira P. Perineal and foot muscle synkinesis following trauma to the sacrum in an adult male - A case of motor root ephaptic transmission? Clin Neurol Neurosurg 2022; 219:107340. [PMID: 35716456 DOI: 10.1016/j.clineuro.2022.107340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/04/2022] [Accepted: 06/12/2022] [Indexed: 11/03/2022]
Abstract
Ephaptic transmission has been proven as an alternative to chemical synaptic neural transmission and occurs in pathological situations, such as epilepsy and demyelination. Hereby, we report the case of an adult male that in 2012 was involved in a low-speed motorcycle accident with sacrum impact that from day three onwards reported unwanted penile movement when performing hallux and toe plantar flexion of the right foot. Urologic studies and perineal MRI were unremarkable but sacral MRI showed a significantly stenotic canal at the S1-S2 level while EMG displayed chronic moderate right S2 radiculopathy. Nine years later the patient underwent surgical decompression of the sacral canal with complete resolution of the synkinesis. We hypothesize ephaptic transmission between adjacent motor nerve fibres at the S2 sacral nerve root to be the likely mechanism explaining this phenomenon.
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Affiliation(s)
- Pedro Valente Aguiar
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Fernando Silveira
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rui Vaz
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Neurosciences Centre, Hospital CUF Porto, Portugal
| | - Paulo Linhares
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Neurosciences Centre, Hospital CUF Porto, Portugal
| | - Paulo Pereira
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Neurosciences Centre, Hospital CUF Porto, Portugal
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Bologna M, Valls-Solè J, Kamble N, Pal PK, Conte A, Guerra A, Belvisi D, Berardelli A. Dystonia, chorea, hemiballismus and other dyskinesias. Clin Neurophysiol 2022; 140:110-125. [PMID: 35785630 DOI: 10.1016/j.clinph.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Abstract
Hyperkinesias are heterogeneous involuntary movements that significantly differ in terms of clinical and semeiological manifestations, including rhythm, regularity, speed, duration, and other factors that determine their appearance or suppression. Hyperkinesias are due to complex, variable, and largely undefined pathophysiological mechanisms that may involve different brain areas. In this chapter, we specifically focus on dystonia, chorea and hemiballismus, and other dyskinesias, specifically, levodopa-induced, tardive, and cranial dyskinesia. We address the role of neurophysiological studies aimed at explaining the pathophysiology of these conditions. We mainly refer to human studies using surface and invasive in-depth recordings, as well as spinal, brainstem, and transcortical reflexology and non-invasive brain stimulation techniques. We discuss the extent to which the neurophysiological abnormalities observed in hyperkinesias may be explained by pathophysiological models. We highlight the most relevant issues that deserve future research efforts. The potential role of neurophysiological assessment in the clinical context of hyperkinesia is also discussed.
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Affiliation(s)
- Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Josep Valls-Solè
- Institut d'Investigació Biomèdica August Pi I Sunyer, Villarroel, 170, Barcelona, Spain
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | | | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy.
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Factors Related to Hemifacial Spasm Recurrence in Patients Undergoing Microvascular Decompression—A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:brainsci12050583. [PMID: 35624968 PMCID: PMC9139130 DOI: 10.3390/brainsci12050583] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/10/2022] Open
Abstract
There is a lack of knowledge about the factors associated with the recurrence of hemifacial spam (HFS) following an initially successful microvascular decompression (MVD) surgery. The aim of the present study was to systematically review the pertinent literature and carry out a meta-analysis of factors linked to HFS recurrence in patients undergoing initially successful MVD treatment. An online literature search was launched on the PubMed/Medline and Scopus databases. The following data were collected: sex, age at surgery, affected side, reported improvement after surgery, presence of post-operatory facial weakness, symptom duration, offender vessels, and data obtained from intraoperative neurophysiological monitoring. Upon full-text review, eight articles were included, studying 1105 patients, of which 64 (5.7%) reported recurrence after MVD surgery for hemifacial spasm. There was a statistically significant increased incidence of HFS recurrence in patients with the persistence of lateral spread response (LSR after surgery (OR 9.44 (95% CI 1.69–52.58) p 0.01), while those patients experiencing a shorter disease duration before going to surgery were significantly less prone to experiencing disease recurrence (OR 0.11 (95% CI 0.03–0.46) p 0.002). The remaining examined factors did not result as significantly associated with the risk of recurrence. The funnel plots were largely symmetrical for each variable studied. Taken together, the results of our meta-analysis seem to suggest that short-term symptom duration is a protective factor against HFS recurrence after MVD surgery, while LSR persistence is a negative prognostic factor. Well-designed randomized controlled clinical trials with a long follow-up are expected to further explore therapeutic alternatives for HFS recurrence.
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18
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Kulkarni A. Complex Neurovascular Syndromes: Is the Compressing Vessel Alone the Culprit? J Neurosci Rural Pract 2022; 13:283-289. [PMID: 35694065 PMCID: PMC9187378 DOI: 10.1055/s-0042-1744125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Abstract
Objective To describe and correlate the clinical, radiological, and intraoperative findings in patients with refractory neurovascular syndromes (NVS) not responding to conventional medical management and to determine the surgical outcome of the microvascular decompression (MVD) procedure.
Methods Medical records of 17 patients with NVS (trigeminal neuralgia [TN] = 14 and hemifacial spasm = 3) who underwent surgery for symptom relief from January 2018 to July 2021 with follow-up data (1–36 months) were retrospectively analyzed. Patient demographics (age, sex), clinical features (site, duration of symptoms, distribution), magnetic resonance imaging (MRI) findings, micro-neurosurgical details (type of surgery, obstructive vessel), and postoperative outcome and complications were recorded.
Statistical Analysis Descriptive analysis was performed. Variables were presented as either mean and standard deviation or frequency and percentages.
Results The mean (standard deviation) age of patients in our study cohort was 52.6 (12.2) years. TN was common in females (64.3%). The mean duration of symptoms was longer in patients with hemifacial spasms than in patients with TN (3.3 vs. 2.7 years). While the right side was commonly affected in TN (64.3%), the left side was common in hemifacial spasm (66.7%). Most common neuralgia symptoms were distributed along the V2V3 (maxillary and mandibular division) branches (42.9%). MRI revealed neurovascular conflict in nine patients, epidermoid tumor in three patients, classical vestibular schwannoma in two patients, and short cisternal segments in three patients. Intraoperatively, superior cerebellar artery was the main offending vessel in TN followed by anterior inferior cerebellar artery (AICA) and venous compression, while tortuous vertebral artery and AICA along with thickened entangled arachnoid were seen in hemifacial spasms. Almost all patients (88.2%) reported immediate postoperative complete pain relief. One patient died secondary to chest infection after a month.
Conclusion Arachnoid entanglement around the neurovascular bundle along with vascular compression over the cranial nerves is the main cause of NVS. Advanced micro-neurosurgical techniques used in MVD achieve excellent outcomes with improved quality of life. However, identifying the refractory NVS not responding to conventional medical management and early surgical management are paramount.
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Affiliation(s)
- Aniruddh Kulkarni
- Department of Neuro and Spine Surgery, Neuro World and Suchirayu Hospital, Hubli, Karnataka, India
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19
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Sprenghers L, Lemmens R, van Loon J. Usefulness of intraoperative monitoring in microvascular decompression for hemifacial spasm: a systematic review and meta-analysis. Br J Neurosurg 2022; 36:346-357. [PMID: 35313771 DOI: 10.1080/02688697.2022.2049701] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To review the diagnostic accuracy and possible added value of Brainstem Auditory Evoked Potentials (BAEP) monitoring and Lateral Spread Response (LSR) monitoring in microvascular decompression surgery for hemifacial spasms. METHODS For this systematic review we followed the PRISMA guidelines. We searched different databases and bibliographies of articles. We included studies on BAEP and LSR monitoring that reported data on hearing outcome or efficacy. Selected studies were assessed for bias using the MINORS tool. RESULTS 64 articles were selected for qualitative synthesis, 42 met inclusion criteria for meta-analysis. The overall incidence of hearing loss was 3.4%. For BAEP monitoring AUC and pooled OR with 95% confidence interval were 0.911 (0.753-0.933) and 7.99 (3.85-16.60) respectively. Short-term data on LSR monitoring showed an overall spasm relief rate of 89% with pooled OR, sensitivity and specificity with a 95% confidence interval of 8.80 (4.82-16.08), 0.911 (0.863-0.943) and 0.451 (0.342-0.564) respectively. Long-term data on LSR monitoring showed an overall spasm relief rate of 95% with pooled OR, sensitivity and specificity with a 95% confidence interval of 4.06 (2.15-7.64), 0.871 (0.817-0.911) and 0.39 (0.294-0.495) respectively. CONCLUSION The alarm criteria, a wave V latency prolongation of 1ms or a wave V amplitude decrement of 50%, proposed by the 'American Clinical Neurophysiology Society' are a sensitive predictor for postoperative hearing loss. Other BAEP wave changes, for example, complete loss of wave V, are more specific but correspond to irreversible damage and are therefore not useful as warning criteria. LSR monitoring has high diagnostic accuracy at short-term follow-up. At long-term follow-up, diagnostic accuracy decreases because most patients get spasm relief regardless of their LSR status. LSR persistence after surgery has a good long-term outcome, as long as an extensive exploration of the facial nerve has been performed.
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Affiliation(s)
| | - Robin Lemmens
- Department of Neurology, University Hospital Leuven, University of Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospital Leuven and Laboratory of Experimental Neurosurgery and Neuroanatomy, University of Leuven, Leuven, Belgium
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20
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Wei J, Hu X, Xia L, Shang J, Han Q, Zhang D. Evaluation of the effect of botulinum toxin A on the physical and mental health of patients with hemifacial spasm. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Jost WH, Laskawi R, Palmowski-Wolfe A, Spittau B, Urban PP. [Therapy of Hemifacial Spasm with Botulinum Toxin: an Update]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:37-41. [PMID: 35021244 DOI: 10.1055/a-1677-4008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Injections of botulinum toxin can be viewed by now as the therapy of choice in treating hemifacial spasm (HFS). Each of the three botulinum toxin-A preparations have been approved for this indication in Germany. HFS is a frequent disease characterized by involuntary contractions of the muscles of one half of the face innervated by the facial nerve. The symptoms can be either tonic or clonic, intermittant or permanent. Diagnosis is based purely on clinical observation. A magnetic resonance imagingof the skull is appropriate to demonstrate nerve-vessel contact as most frequent cause and to exclude other pathologies.
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Affiliation(s)
| | - Rainer Laskawi
- Hals-Nasen-Ohrenklinik, Universitätsmedizin Göttingen, Göttingen
| | | | - Björn Spittau
- Anatomie und Zellbiologie, Medizinische Fakultät OWL, Universität Bielefeld
| | - Peter P Urban
- Asklepios Klinik Barmbek, Abt. für Neurologie, Hamburg
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22
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Tommy T, Sakarunchai I, Yamada Y, Yoshida K, Kawase T, Kato Y. The Use of Fusion Images as a Diagnostic and Neurosurgical Planning Tool in Microvascular Decompression. Asian J Neurosurg 2021; 16:562-566. [PMID: 34660369 PMCID: PMC8477840 DOI: 10.4103/ajns.ajns_413_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/07/2020] [Accepted: 02/15/2021] [Indexed: 12/01/2022] Open
Abstract
Preoperative assessment of surgery using high-quality images can help surgeons to achieve best result of treatment. With the advances in computer technology, interactive multimodality fusion images have been developed. The use of fusion images as a preoperative planning tool is described with its examples in illustrative cases of trigeminal neuralgia and hemifacial spasm microvascular decompression (MVD). Interactive computer graphics such as multimodality fusion method is a useful tool to preoperatively predict the need of bone exposure and configuration of blood vessels with its correlation to cranial nerves in MVD.
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Affiliation(s)
- Thomas Tommy
- Department of Neurosurgery, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Ittichai Sakarunchai
- Department of Surgery, Division of Neurosurgery, Prince of Songkla University, Songkla, Thailand
| | - Yasuhiro Yamada
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | - Koichiro Yoshida
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | - Yoko Kato
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
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Dudoit T, Balossier A, Reyes-Botero G, Laigle-Donadey F, Emery E, Blond S, Carluer L, Lechapt-Zalcman E, Delattre JY, Guillamo JS. Adult brainstem glioma presenting with isolated persistent hemifacial spasm or facial nerve palsy. Rev Neurol (Paris) 2021; 177:1276-1282. [PMID: 34272066 DOI: 10.1016/j.neurol.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
OBJECT Adult brainstem gliomas are a rare group of heterogeneous brain tumors. Classical clinical presentation includes progressive impairment of cranial nerves associated with long tract signs. The prognosis and response to treatment are poor; nevertheless, some patients do have a long survival. The objective of this study was to describe a series of patients with an isolated persistent hemifacial spasm and/or facial nerve palsy as the presenting symptom of a brainstem glioma. METHODS Fourteen patients from 3 French hospitals (Paris, Caen, Lille) were included. Clinical and radiological features and overall survival were retrospectively analyzed. A review of the literature of similar cases was performed. RESULTS Mean age at diagnosis was 35 years (range 19-57 years). Mean duration of facial nerve involvement before diagnosis was 17 months (range 1-48 months). Tumors were characterized on MRI by a lateralized location in the pons, a T1-weighted hyposignal, a T2-weighted hypersignal and no contrast enhancement after Gadolinium injection except for 2 cases. Biopsies were performed in 10 cases and showed 8 low-grade and 2 high-grade gliomas. All the patients were initially treated with radiotherapy and 6 patients with chemotherapy after progression. Eleven patients died from tumor progression. Median survival time was 90 months. CONCLUSIONS Adult brainstem gliomas revealed by a progressive isolated involvement of the facial nerve seem to have particular clinico-radiological features of slow progressive tumors and may be associated with long patient survival.
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Affiliation(s)
- T Dudoit
- Service de neurochirurgie, CHU de Caen, 14000 Caen, France
| | - A Balossier
- Service de neurochirurgie, CHU de Caen, 14000 Caen, France; Université de Caen Basse-Normandie, UFR de Médecine, 14000 Caen, France
| | - G Reyes-Botero
- Service de neurologie Mazarin, groupe hospitalier Pitié-Salpêtrière, université Pierre et Marie Curie-Paris 6, AP-HP, Paris, France
| | - F Laigle-Donadey
- Service de neurologie Mazarin, groupe hospitalier Pitié-Salpêtrière, université Pierre et Marie Curie-Paris 6, AP-HP, Paris, France
| | - E Emery
- Service de neurochirurgie, CHU de Caen, 14000 Caen, France; Université de Caen Basse-Normandie, UFR de Médecine, 14000 Caen, France
| | - S Blond
- Service de neurochirurgie, CHRU de Lille, 59037 Lille, France
| | - L Carluer
- Service de neurologie, CHU de Caen, 14000 Caen, France
| | | | - J-Y Delattre
- Service de neurologie Mazarin, groupe hospitalier Pitié-Salpêtrière, université Pierre et Marie Curie-Paris 6, AP-HP, Paris, France
| | - J-S Guillamo
- Université de Caen Basse-Normandie, UFR de Médecine, 14000 Caen, France; Service de neurologie, CHU de Caen, 14000 Caen, France; Service de neurologie, CHU de Nîmes, 30029 Nîmes, France.
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Zhong Z, Xiong J, Lu L, Chen J, Tang G, Zhu S, Zhou X, Guo H. Efficacy of fire needle on patients of facial spasm: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e22731. [PMID: 33120772 PMCID: PMC7581102 DOI: 10.1097/md.0000000000022731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Facial spasm causes a lot of troubles to patients daily life and seriously affects their mental and physical health. Relevant studies have shown that fire needle therapy has certain benefits for facial spasm, is an integral part of acupuncture therapy. However, there is no unanimous conclusion. The main purpose of our study is to measure whether fire needle therapy is effective for facial spasm. METHODS The following electronic databases will be searched for the collection of fire-needle related randomized controlled trials (RCTS) for facial spasm, including 4 English databases (Web of Science, the Cochrane Library, EMBASE, Pubmed) and 3 Chinese databases (Chinese National Knowledge Infrastructure [CNKI], Wanfang data, Chinese VIP Information). The cure rate and total effective rate are the main outcomes, while the intensity, frequency, recurrence rate and adverse events are the secondary outcomes. We will use Endnote software X9 for study selection, Review Manager software 5.4 and STATA 13.0 software for analysis and synthesis. RESULTS We will evaluate the efficacy of fire needles in the treatment of facial spasm in combination with current studies. CONCLUSION The conclusion of this study will provide evidence for the efficacy of fire needle in the treatment of facial spasm. TRIAL REGISTRATION NUMBER INPLASY202080036.
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Affiliation(s)
- Zhiying Zhong
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine
| | - Jun Xiong
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine
| | - Lunbin Lu
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jun Chen
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Genhua Tang
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Siyuan Zhu
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xingchen Zhou
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Han Guo
- Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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Navarro-Olvera JL, Covaleda-Rodriguez JC, Diaz-Martinez JA, Aguado-Carrillo G, Carrillo-Ruiz JD, Velasco-Campos F. Hemifacial Spasm Associated with Compression of the Facial Colliculus by a Choroid Plexus Papilloma of the Fourth Ventricle. Stereotact Funct Neurosurg 2020; 98:145-149. [PMID: 32316018 DOI: 10.1159/000507060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hemifacial spasm is an involuntary condition that involves muscles innervated by the ipsilateral facial nerve. There are secondary causes of hemifacial spasm that can produce a typical presentation of symptoms. Extrinsic compression of the facial colliculus at the floor of the fourth ventricle is responsible for <0.6% of the causes of secondary hemifacial spasm, as the cases with this origin reported in the literature are rare. CASE REPORTS We present the case of a 43-year-old female with hemifacial spasm of typical characteristics 6 months after onset. Upon clinical examination, a severe contraction of the orbicularis oculi, orbicularis oris, and superficial muscles of the neck displaying 50 crisis per hour was revealed. Brain magnetic resonance imaging showed absence of the facial nerve vascular loop in the cisternal portion, with evidence of an intraventricular tumor in relation with the medial portion of the fourth ventricle at the facial colliculus level, indicating a secondary origin of hemifacial spasm. Preoperative electromyography demonstrated irritative electric activity in the muscular branches of the facial nerve. A telovelar approach was performed to the fourth ventricle with intraoperative electrophysiology monitoring, with immediate resolution of the irritative activity after complete tumor resection. The result of the histopathologic study was a choroid plexus papilloma. CONCLUSION Fourth ventricle tumors with extrinsic compression of the facial colliculus represent <0.6% of the causes of hemifacial spasm. Its relationship with choroid plexuses papilloma is being described as the first case reported in the literature. Clinical correlation, imaging, and intraoperative findings in conjunction with intraoperative electrophysiology recordings allow to predict the resolution of symptoms after resecting the lesion.
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Affiliation(s)
- José Luis Navarro-Olvera
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico,
| | | | | | - Gustavo Aguado-Carrillo
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | | | - Francisco Velasco-Campos
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
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Morsy MM, Foaud WA, Abu-Elenain HA, Aly MA. Endoscopic assisted microvascular decompression versus new antiepileptics and BOTOX in treatment of hemifacial spasm: a clinical trial. EGYPTIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1186/s41984-019-0070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Hemifacial spasm (HFS) is a chronic movement disorder characterized by twitching of muscles of facial expression which is innervated by the facial nerve. The condition is unilaterally, beginning in the orbicularis occuli, and later on progress to involve the perioral, platysma, and other muscles of facial expression. Endoscopic assisted microvascular decompression is considered the state of the art in hemi-facial spasm surgery. New antiepileptic have emerged with a new hope for good control with few side effects. Botulinum toxin is still a good option for some patients.
Methods
This study is a prospective study that was conducted on 30 patients with primary hemifacial spasm. Bilateral and secondary cases where excluded. All patients were subjected to proper pre-treatment assessment including; proper history taking, clinical examination, and proper radiological investigations (MRI, FISTA) when needed. They were divided into three groups according to treatment modality: group A where patient's general condition was unfit for surgical intervention, received oral medications (gabapentin or levetiracetam); group B included those patients unfit for surgical intervention and did not respond to oral therapy, received Botox injection; and group C underwent endoscopic assisted microvascular decompression. Follow-up period ranged from 6 to 24 months. Outcome of different treatment modalities were compared among different groups.
Results
Among group A patients, one patient showed excellent response to treatment (Gabapentin 1200 mg), three patients had good response, four patients had fair response, and three patients had poor response to treatment (one used levetiracetam, two used gabapentin). Overall success rate is 72.7%. Among group B patients, four patients enjoyed excellent response. Another four patients had good response, while three patients had fair response. Only one patient had poor response. Overall success rate was 83.3%. Among group C patients, five cases had excellent outcome and two cases had good outcome. Overall success rate is 100%.
Conclusion
Endoscopic assisted microvascular decompression offers the best chance to permanent cure with low complication rate. New antiepileptics (levetiracetam, gabapentin) provide a safe therapy for patients refusing surgical intervention. Botox is an attractive local therapy with reversible complications but with non-sustainable effect. From our results, we conclude that endoscopic assisted microvascular decompression is superior to either BOTOX or antiepiletics for the permanent cure of hemifacial spasm.
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Osaki TH, Osaki MH, Garcia DM, Osaki T, Ohkawara L, Belfort R, Cruz AAV. Evaluation of botulinum toxin effects in hemifacial spasm patients: correlation between clinical rating scales and high-speed video system measurements. J Neural Transm (Vienna) 2020; 127:1041-1046. [PMID: 32232566 DOI: 10.1007/s00702-020-02183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to compare the scores of two clinical rating scales and high-speed video system measurements obtained during spontaneous eyelid movements in hemifacial spasm (HFS) patients before and after treatment. Patients were evaluated before and 30 days after receiving treatment with onabotulinumtoxinA injections. Using a high-speed video system, the eyelid movements were recorded bilaterally for 3 min and the energy power generated by the upper eyelid during spontaneous eyelid movements was assessed before and after treatment. The scores of the Jankovic rating scale (JRS) and Hemifacial Spasm Grading System (HSGS) were also assessed before and after treatment. The authors studied 22 patients. Significant reduction in JRS and HSGS scores and in the energy generated by the upper eyelid was observed after treatment. A power spectrum of less than 23,000 was associated with JRS and HSGS scores less than 4 and 6.25, respectively and a power spectrum greater than or equal to 23,000 was associated with JRS and HSGS scores greater than or equal to 4 and 6.25, respectively (p < 0.0001 and p = 0.0025). Rating systems are easy to use, but they may exhibit limitations in sensitivity to assess differences between distinct disease patterns and between subtle differences in treatment responses. The high-speed video system permits a greater degree of accuracy, which allows for the assessment of differences in eyelid movement patterns and would permit better tailoring of treatment to patients. However, simpler devices employing this system would need to be developed, so that it could be used in clinical practice.
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Affiliation(s)
- Tammy H Osaki
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo-EPM/UNIFESP, São Paulo, SP, Brazil
- Department of Ophthalmology, University of Santo Amaro, São Paulo, SP, Brazil
- Osaki Clinics, R. Vergueiro, 2045 cj. 1009, São Paulo, SP, 04101-000, Brazil
| | - Midori H Osaki
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo-EPM/UNIFESP, São Paulo, SP, Brazil.
- Osaki Clinics, R. Vergueiro, 2045 cj. 1009, São Paulo, SP, 04101-000, Brazil.
| | - Denny M Garcia
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of S. Paulo/Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Teissy Osaki
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo-EPM/UNIFESP, São Paulo, SP, Brazil
- Osaki Clinics, R. Vergueiro, 2045 cj. 1009, São Paulo, SP, 04101-000, Brazil
| | - Lilian Ohkawara
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo-EPM/UNIFESP, São Paulo, SP, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of Sao Paulo-EPM/UNIFESP, São Paulo, SP, Brazil
| | - Antonio Augusto V Cruz
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, University of S. Paulo/Ribeirão Preto, Ribeirão Preto, SP, Brazil
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Basheikh MA. Reversible Hemifacial Spasm after Starting Escitalopram. Case Rep Neurol 2020; 12:103-106. [PMID: 32308604 PMCID: PMC7154230 DOI: 10.1159/000506326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/30/2020] [Indexed: 11/19/2022] Open
Abstract
This is a case of a patient who developed hemifacial spasm after he was started on escitalopram. His symptoms got worse after the dose was increased. The spasm resolved after the medication was stopped gradually. This is an unreported adverse effect of escitalopram or any selective serotonin reuptake inhibitor.
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Pellegrini M, Schiavi C, Taroni L, Sebastiani S, Bernabei F, Roda M, Moscardelli F, Giannaccare G. Ocular surface status in patients with hemifacial spasm under long-lasting treatment with botulinum A toxin: A comparative fellow eye study. Indian J Ophthalmol 2020; 67:1405-1409. [PMID: 31436182 PMCID: PMC6727720 DOI: 10.4103/ijo.ijo_41_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose: The purpose of this study was to assess the effect of long-lasting botulinum A toxin injections on ocular surface parameters and to further investigate the relationship between these parameters and the duration of the treatment. Methods: In this retrospective study, patients with unilateral hemifacial spasm who were receiving botulinum A toxin injections for at least 1 year were analyzed. Healthy contralateral eyes acted as controls. The ocular surface examination included Ocular Surface Disease Index questionnaire, Schirmer test type I, tear film break-up time (TFBUT), tear osmolarity, corneal sensitivity, and corneal fluorescein staining. Results: Twenty-six patients (6 males and 20 females; mean age 76.4 ± 8.9 years) were included in the study. The mean duration of the treatment was 7.2 ± 5.4 years, and the mean frequency of injections was of one every 3.3 ± 0.4 months. TFBUT, Schirmer test, and corneal sensitivity were significantly lower in the eye homolateral to hemifacial spasm compared with the contralateral one (5.9 ± 3.2 vs 7.5 ± 4.2 s, P = 0.001; 6.2 ± 3.4 vs 9.2 ± 6.6 mm, P = 0.031; 50.8 ± 3.7 mm vs 52.3 ± 2.9 mm, P = 0.048, respectively). One month after the last injection, TFBUT further decreased from 5.9 ± 3.2 to 2.3 ± 1.2 s (P = 0.028). A significant positive correlation was found between the duration of treatment and tear osmolarity (ρ = 0.542, P = 0.025). Conclusion: Patients with hemifacial spasm under long-lasting treatment with serial botulinum A toxin injections showed a reduction in tear film production and stability, as well as corneal sensitivity in the treated eye compared with the contralateral one. Tear film stability further decreased 1 month after the last injection.
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Affiliation(s)
- Marco Pellegrini
- Department of Ophthalmology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Costantino Schiavi
- Department of Ophthalmology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Leonardo Taroni
- Department of Ophthalmology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Stefano Sebastiani
- Department of Ophthalmology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Federico Bernabei
- Department of Ophthalmology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Matilde Roda
- Department of Ophthalmology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Fabiana Moscardelli
- Department of Ophthalmology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Osaki MH, Osaki TH, Garcia DM, Osaki T, Gameiro GR, Belfort R, Cruz AAV. Analysis of blink activity and anomalous eyelid movements in patients with hemifacial spasm. Graefes Arch Clin Exp Ophthalmol 2019; 258:669-674. [DOI: 10.1007/s00417-019-04567-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/18/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022] Open
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Yang H, Zhou J, Zhong D, Yin Z, Xu G, Chen J, Li J, Liang F. Acupuncture therapy for patients with hemifacial spasm: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18329. [PMID: 31860984 PMCID: PMC6940167 DOI: 10.1097/md.0000000000018329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hemifacial spasm (HFS) brings a lot of trouble to patients' daily life, having a severe influence on the psychological and physical wellbeing of patients. Relevant researches suggested that acupuncture therapy has potential benefits for HFS. However, there is no consistent conclusion. The purpose of our study is to assess whether acupuncture therapy is effective and safe for HFS. METHODS To collect relevant randomized controlled trials (RCTs), the following electronic databases will be searched: Web of Science, the Cochrane Library, EMBASE, MEDLINE, ISI Web of Knowledge, PsycINFO, Allied and Alternative Medieine, Chinese National Knowledge Infrastructure, Wanfang data, and Chinese Scientific Journals Database. We will take the cure rate and the total effective rate as the primary outcomes, and change in intensity after treatment, change in frequency after treatment, the recurrence rate, and adverse events as secondary outcomes. Endnote software 9.1 will be used for study selection, Review Manager software 5.3, and STATA 13.0 software will be used for analysis and synthesis. RESULTS Current relevant studies will be synthesized to assess whether acupuncture therapy is effective and safe for HFS. CONCLUSION Our research will provide evidence of acupuncture therapy for HFS. REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42019142473.
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Affiliation(s)
- Han Yang
- College of Acupuncture and Moxibustion and Tuina
| | - Jun Zhou
- College of Acupuncture and Moxibustion and Tuina
| | - Dongling Zhong
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zihan Yin
- College of Acupuncture and Moxibustion and Tuina
| | - Guixing Xu
- College of Acupuncture and Moxibustion and Tuina
| | - Jiao Chen
- College of Acupuncture and Moxibustion and Tuina
| | - Juan Li
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Yuksel B, Genc F, Yaman A, Goksu EO, Ak PD, Gomceli YB. Evaluation of stigmatization in hemifacial spasm and quality of life before and after botulinum toxin treatment. Acta Neurol Belg 2019; 119:55-60. [PMID: 30178181 DOI: 10.1007/s13760-018-1018-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 08/31/2018] [Indexed: 01/15/2023]
Abstract
Hemifacial spasm (HFS) is a chronic disease that is characterized by involuntary tonic and clonic contractions of the muscles innervated by the ipsilateral facial nerve. Botulinum toxin (BTX) is the most effective medical treatment of this condition. The aim of our study was to evaluate stigma among patients diagnosed with HFS and to search quality of life and depression before and after BTX injection. Seven self-rating items (HFS-7) and seven questions related to stigmatization were administered to HFS patients. Participants also answered SF-36 health outcome measure and Beck depression inventory before and 4 weeks after the routine BTX injection. The severity of HFS was graded based on a five-point scale. Descriptive statistics and paired t test were applied. The level of significance was set at α = 0.05. Fourty HFS patients were prospectively included. Twenty-one (%52.5) were female and nineteen were male (47.5%) with a mean age of 57.1 (SD = 12.13; min-max = 27-78). 60% (n: 24) of patients were feeling themselves different from people without HFS. Beck depression inventory scores improved after BTX injection significantly (p < 0.05). All domains of SF-36 showed positive improvement after BTX injections. The improvement in general health perception, physical functioning, and vitality was statistically significant (p < 0.05). Although more than half of the patients felt themselves different from people without HFS, treatment of HFS with BTX significantly improved mental health and physical health, and depressive symptoms of the patients.
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Affiliation(s)
- Burcu Yuksel
- Neurology Department, Antalya Training and Research Hospital, Muratpasa, 07050, Antalya, Turkey.
| | - Fatma Genc
- Neurology Department, Antalya Training and Research Hospital, Muratpasa, 07050, Antalya, Turkey
| | - Aylin Yaman
- Neurology Department, Antalya Training and Research Hospital, Muratpasa, 07050, Antalya, Turkey
| | - Eylem Ozaydin Goksu
- Neurology Department, Antalya Training and Research Hospital, Muratpasa, 07050, Antalya, Turkey
| | - Pelin Dogan Ak
- Neurology Department, Fatih Sultan Mehmet Training and Research Hospital, Kadıkoy, 34752, Istanbul, Turkey
| | - Yasemin Bicer Gomceli
- Neurology Department, Antalya Training and Research Hospital, Muratpasa, 07050, Antalya, Turkey
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Gosal JS, Das KK, Khatri D, Attri G, Jaiswal AK. "Contralateral Dry Eye in Hemifacial Spasm:" A New Clinical Sign. Asian J Neurosurg 2019; 14:996-998. [PMID: 31497150 PMCID: PMC6703023 DOI: 10.4103/ajns.ajns_48_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Hemifacial spasm (HFS) is a benign condition characterized by unilateral, involuntary, paroxysmal clonic and tonic contractions of the facial muscles. This condition usually results from a focal demyelination at the root entry zone of the 7th cranial nerve secondary to a vascular loop compression, and hence, it responds to microvascular decompression (MVD) surgery, similar to trigeminal neuralgia. Herein, we report an interesting clinical finding of a contralateral dry eye in the case of HFS, which has not been described previously and discuss the possible underlying mechanisms. A 53-year-old man presented with a 6-month history of involuntary twitching movements of the left hemiface that persisted during sleep, consistent with the diagnosis of HFS. The patient's attempts to voluntarily control the troublesome involuntary left-sided eye blinking led to the development of dryness and reddening of the right eye. Corneal reflex, both direct and consensual, was intact bilaterally, and an ophthalmological examination ruled out the diagnosis of conjunctivitis. The patient underwent MVD of the facial nerve. To our surprise and validating our supposition, his contralateral conjunctival hyperemia and dry eye resolved within a day of surgery, along with complete resolution of the HFS. HFS can lead to the contralateral dry eye from the voluntary suppression of ocular blinking which resolves following MVD. We demonstrate this finding for the first time and believe its recognition may be of value in the patient management.
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Affiliation(s)
- Jaskaran Singh Gosal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deepak Khatri
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gagandeep Attri
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract
Neuromyotonic and myokymic discharges are abnormal electrical muscular discharges caused by ectopic discharges from motor axons and represent the hallmarks of peripheral nerve hyperexcitability. Neuromyotonic discharges are specific for peripheral nerve hyperexcitability syndromes, whereas myokymic discharges may occur either focally or in a more generalized fashion in many other peripheral nerve disorders. Isaacs syndrome and Morvan syndrome are rare acquired peripheral nerve hyperexcitability disorders that share common clinical features and are often associated with elevated voltage-gated potassium channel-complex antibodies. Central nervous system symptomatology is more common in Morvan syndrome, which also overlaps with limbic encephalitis. Cramp-fasciculation syndrome, a more common syndrome, may represent a milder form of peripheral nerve hyperexcitability. Peripheral nerve hyperexcitability syndromes should be distinguished from stiff person syndrome, myotonic disorders, and rippling muscle disease. When severe, Isaacs syndrome and Morvan syndrome may be disabling but often respond to membrane-stabilizing drugs and immunomodulatory treatments. The electrophysiologic features of these disorders are described.
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Affiliation(s)
- Bashar Katirji
- Neuromuscular Center and EMG Laboratory, Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States.
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Sharma PS, Sattur AP, Patil PB, Nandimath KR, Guttal KS, Burde K. Hemifacial spasm secondary to vascular loop compression: a rare case report. Oral Radiol 2018; 34:273-276. [PMID: 30484026 DOI: 10.1007/s11282-017-0296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/04/2017] [Indexed: 11/25/2022]
Abstract
Hemifacial spasm (HFS) is characterised by brief, persistent, involuntary paroxysmal contractions of the facial muscles innervated by the facial nerve. Broadly its aetiology is portrayed as primary and secondary. Primary HFS is a result of vascular compression of the ipsilateral facial nerve at its root exit zone, and secondary HFS can occur after any injury to the facial nerve from the internal auditory canal to the stylomastoid foramen, which may be a result of a cerebellopontine angle tumour, schwannoma, fusiform aneurysm, or demyelinating lesion such as multiple sclerosis. We report a rare case of HFS in a 40-year-old female patient, who presented with a 4-year history of twitching of the left eye and deviation of the mouth towards the left side. An MRI of the brain revealed a vascular anomaly at the root exit zone of the left facial nerve. The present report aims to highlight MRI as a single, non-invasive diagnostic investigation to confirm the diagnosis of HFS.
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Affiliation(s)
- Pratibha S Sharma
- Department of Oral Medicine and Radiology, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, 580009, India.
| | - Atul P Sattur
- Department of Oral Medicine and Radiology, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, 580009, India
| | - Preetam B Patil
- Department of Radiodiagnosis, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, 580009, India
| | - Kirty R Nandimath
- Department of Oral Medicine and Radiology, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, 580009, India
| | - Kruthika S Guttal
- Department of Oral Medicine and Radiology, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, 580009, India
| | - Krishna Burde
- Department of Oral Medicine and Radiology, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, 580009, India
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Sohal M, Karter N, Eisen M. Hemifacial spasm secondary to middle ear cholesteatoma. EAR, NOSE & THROAT JOURNAL 2018; 97:E31-E32. [PMID: 30036421 DOI: 10.1177/014556131809700602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hemifacial spasm is a peripheral myoclonus of the VIIth cranial nerve that is characterized by paroxysmal contraction of the muscles of facial expression. It exists in both primary and secondary forms. In rare cases, hemifacial spasm is caused by middle ear pathology. We describe the case of a 90-year-old man with recurrent cholesteatoma and tympanic segment fallopian canal dehiscence manifesting as right-sided hemifacial spasm. His history was significant for a right-sided tympanomastoidectomy for cholesteatoma 6 years earlier. Computed tomographic angiography performed to look for vascular compression of the facial nerve demonstrated a right middle ear opacification. Middle ear exploration revealed a completely dehiscent tympanic segment with cholesteatoma abutting the facial nerve. The overlying keratin debris and matrix were carefully dissected off, and facial nerve function was preserved. The final diagnosis was hemifacial spasm. During 14 months of postoperative follow-up, the patient experienced no further facial spasm.
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Affiliation(s)
- Maheep Sohal
- Division of Otolaryngology-Head and Neck Surgery, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030, USA.
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What Should We Do for Those Hemifacial Spasm Patients Without Efficacy Following Microvascular Decompression: Expectation of Delayed Relief or Early Reoperation? World Neurosurg 2018; 110:e897-e900. [DOI: 10.1016/j.wneu.2017.11.118] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 11/18/2022]
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Xu XL, Zhen XK, Yuan Y, Liu HJ, Liu J, Xu J, Li XB, Zhang L, Yu YB. Long-Term Outcome of Repeat Microvascular Decompression for Hemifacial Spasm. World Neurosurg 2017; 110:e989-e997. [PMID: 29203317 DOI: 10.1016/j.wneu.2017.11.144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/23/2017] [Accepted: 11/25/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although repeat microvascular decompression (MVD) for hemifacial spasm (HFS) in patients with failed prior MVD is potentially curative, little is known about the long-term results of repeat MVD. We aimed to evaluate the long-term outcomes and complications after repeat MVD for HFS. METHODS We performed repeat MVD on 78 consecutive patients who had undergone a prior MVD >1 year previously. Follow-up data were available for 58 patients, with a median follow-up period of 8.6 years (range, 6.9-10.2 years). The patients were assessed for intraoperative findings, relief results, and complications at discharge and at follow-up, as well as the associations between the preoperative characteristics and outcomes. RESULTS At discharge, of 78 patients with repeat MVD, 72 (92.3%) achieved complete spasm resolution and 1 (2.6%) had significantly improved spasm resolution. Of all patients, 9% (7 of 78) presented short-term complications, including partial hearing loss, hemifacial paresis, and cerebrospinal fluid leak. At follow-up, 45 of 58 (77.6%) patients had complete relief and 10 of 58 (17.2%) had improved relief. Permanent complications occurred in 14 patients (24.1%), with partial hearing loss and mild hemifacial paresis being the most common. Despite the complications, 51 of 58 patients (91.4%) reported an excellent life quality. No significant correlation was found between preoperative characteristics, such as age, interval to prior MVD, or interval to recurrence, and outcomes including short-term or long-term relief results and complications. CONCLUSIONS Repeat MVD provides lasting relief for most patients with persistent or recurrent HFS, albeit with a relatively high complication rate.
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Affiliation(s)
- Xiao-Li Xu
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Xue-Ke Zhen
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Yue Yuan
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Hong-Ju Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Jiang Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Jun Xu
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Xiu-Bin Li
- Organ Transplantation Institute, The 309th Hospital of Chinese People's Liberation Army, Haidian District, Beijing, People's Republic of China
| | - Li Zhang
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China
| | - Yan-Bing Yu
- Department of Neurosurgery, China-Japan Friendship Hospital, Chaoyang District, Beijing, People's Republic of China.
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Mizuma A, Nagata E, Yasuda T, Kouchi M, Nakayama T, Honma K, Tokuoka K, Kitagawa Y, Nogawa S, Takizawa S. Botulinum toxin A is effective to treat tension-type headache caused by hemifacial spasm. J Clin Neurosci 2017; 44:284-288. [DOI: 10.1016/j.jocn.2017.06.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/21/2017] [Indexed: 12/12/2022]
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Abstract
Objective To examine whether or not an edrophonium challenge test is useful for diagnosing cervical dystonia. Patients We evaluated 10 patients with cervical dystonia and 10 with hemifacial spasms (disease controls). We administered edrophonium and saline in this double-blinded study. Before and after the injection, we recorded the participants' clinical signs using a video camera to assess the objective symptoms every two minutes. Ten minutes after the saline and edrophonium injections, participants evaluated their subjective clinical signs using a visual analog scale. The objective signs on the video recordings were scored by specialists who were blinded to the treatment. The mean visual analog scale scores were compared using the Wilcoxon rank-sum test for paired continuous variables. Results The clinical signs of participants with cervical dystonia were amplified by edrophonium. In contrast, the clinical signs in participants with hemifacial spasms were not affected by the edrophonium challenge test. Conclusion The edrophonium challenge test may be useful for diagnosing cervical dystonia.
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Affiliation(s)
| | - Nagahisa Murakami
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | - Hidetaka Koizumi
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | | | - Yuishin Izumi
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | - Ryuji Kaji
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
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Abstract
The purpose of this article is to study the etiology, treatment, and prognosis of delayed facial palsy (DFP) after microvascular decompression (MVD) for the hemifacial spasm. Between January 2012 and January 2014, 562 patients who underwent MVD for hemifacial spasm at our institution were retrospectively studied. Among 562 patients, 34 patients developed DFP after MVD with an incidence of 6%. The duration of palsy was 15 to 136 days (average 51.2 days). There was statistical relevance between preoperative duration of the course, the facial nerve for indentation, and the incidence of delayed facial paralysis. All the symptoms of facial paralysis were obviously improved. DFP is not an unusual complication after MVD, and prognosis is fairly good.
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Mizobuchi Y, Muramatsu K, Ohtani M, Satomi J, Fushimi K, Matsuda S, Nagahiro S. The Current Status of Microvascular Decompression for the Treatment of Hemifacial Spasm in Japan: An Analysis of 2907 Patients Using the Japanese Diagnosis Procedure Combination Database. Neurol Med Chir (Tokyo) 2017; 57:184-190. [PMID: 28179598 PMCID: PMC5409272 DOI: 10.2176/nmc.oa.2016-0237] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Microvascular decompression (MVD) is widely used as a safe and effective treatment for hemifacial spasm (HFS). However, the extent of application of this therapeutic method and its outcomes in Japan are currently unclear. To address these questions, we analyzed the utilization of MVD for the treatment of HFS during the 33- month period from July 2010 to March 2013. We conducted an analysis on data contained in the Diagnosis Procedure Combination database in Japan. This analysis showed that MVD was used for the treatment of HFS in 2907 cases (men, 916; women, 1991) with 2.2 times more women treated than men. MVD for HFS was most frequently performed in women aged 50 to 69 years; however, most men were aged between 40 and 59 years at the time of the procedure. The numbers of procedures performed per 100,000 population/year were 0.83 overall in Japan, with the numbers larger in prefectures with larger populations. Regarding discharge outcomes, the mortality rate was 0.1%. The mean length of hospital stay in patients undergoing MVD for HFS was 14.7 days. This analysis provides preliminary information regarding the trends in the performance of MVD for the treatment of HFS in Japan. Further studies on other registries that contain data obtained by standardized assessment methods and that include long-term outcomes and postoperative complications are required.
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Affiliation(s)
- Yoshifumi Mizobuchi
- Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health
| | - Makoto Ohtani
- Data Science Center of Occupational Health, University of Occupational and Environmental Health
| | - Junichiro Satomi
- Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health
| | - Shinji Nagahiro
- Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School
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Batisti JPM, Kleinfelder ADF, Galli NB, Moro A, Munhoz RP, Teive HAG. Treatment of hemifacial spasm with botulinum toxin type a: effective, long lasting and well tolerated. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:87-91. [DOI: 10.1590/0004-282x20160191] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/18/2016] [Indexed: 11/22/2022]
Abstract
ABSTRACT Hemifacial spasm (HFS) is a common movement disorder characterized by involuntary tonic or clonic contractions of the muscles innervated by the facial nerve. Objective To evaluate the long-term effect of botulinum toxin type A (BTX-A) in the treatment of HFS. Methods A retrospective analysis of patients treated at the Movement Disorders Outpatient Clinic in the Neurology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, from 2009 to 2013 was carried out. A total of 550 BTX-A injections were administered to 100 HFS patients. Results Mean duration of improvement following each injection session was 3.1 months, mean latency to detection of improvement was 7.1 days and mean success rate was 94.7%. Patients were evaluated at an interval of 5.8 months after each application. Adverse effects, which were mostly minor, were observed in 37% of the patients at least once during follow-up. The most frequent was ptosis (35.1%). Conclusion Treatment of HFS with BTX-A was effective, sustainable and safe and had minimal, well-tolerated side effects.
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Affiliation(s)
- Joseph H Donahue
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908, USA
| | - David A Ornan
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908, USA.
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Liu MX, Zhong J, Xia L, Dou NN, Sun H, Li B, Visocchi M, Li ST. The Significance of Abnormal Muscle Response Monitoring During Microvascular Decompression for Hemifacial Spasm. ACTA NEUROCHIRURGICA. SUPPLEMENT 2017; 124:297-301. [PMID: 28120087 DOI: 10.1007/978-3-319-39546-3_43] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Despite the wide adoption of the abnormal muscle response (AMR) to electrical stimulation of the facial nerve during microvascular decompression (MVD) surgery, the value of AMR in the prognosis of the postoperative outcome is still controversial. In order to better use this intraoperative electrophysiology, it is necessary to further address the relationship between AMR and postoperative results. METHODS Three hundred and thirty-two patients with hemifacial spasm (HFS) in whom MVD surgery was performed and in whom AMR was available were finally enrolled in this study. The intraoperative AMR changes were classified as amplitude ≥ 50 %, <50 %, and disappearance. These changes were retrospectively analyzed in association with intraoperative findings and postoperative outcomes. The follow-up period ranged from 11 to 62 months, with an average of 34.1 months. RESULTS Among the 332 patients with a typical AMR wave recorded at the beginning of the operation, the AMR disappeared in 305, and amplitude was <50 % in 11 and ≥50 % in 16. Of those with AMR disappearance plus those with amplitude < 50 %, 98.4 % achieved relief on the first postoperative day and at the latest follow-up, while of those with amplitude ≥50 %, 18.8 % and 25 %, respectively, achieved relief on the first postoperative day and at the latest follow-up (P < 0.01). Accordingly, a more than 50 % decrease of AMR amplitude may predict a good prognosis. The accuracy, sensitivity, and specificity of AMR monitoring were 97.5 %, 99 %, and 72.2 %, respectively. CONCLUSIONS AMR could be a good tool for successful MVD in patients with HFS when a rational analysis is conducted in association with the intraoperative findings. Persistence of AMR may imply that the real offending vessel was missed. If the entire facial nerve root is cleared of any vessel, a remaining AMR amplitude of less than 50 % might be acceptable. Otherwise, neurocombing is suggested before finishing the operation.
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Affiliation(s)
- Ming Xing Liu
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Jun Zhong
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Lai Xia
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Ning-Ning Dou
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Hui Sun
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Bin Li
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | | | - Shi-Ting Li
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
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Zhao W, Wang Y, Fang Q, Wu J, Gao X, Liu H, Cao L, An J. Changes in neurotrophic and inflammatory factors in the cerebrospinal fluid of patients with postherpetic neuralgia. Neurosci Lett 2017; 637:108-113. [DOI: 10.1016/j.neulet.2016.11.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/18/2016] [Accepted: 11/20/2016] [Indexed: 12/22/2022]
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Distinguishing features of psychogenic (functional) versus organic hemifacial spasm. J Neurol 2016; 264:359-363. [DOI: 10.1007/s00415-016-8356-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/17/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
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The association between vertebrobasilar dolichoectasia and hemifacial spasm. Parkinsonism Relat Disord 2016; 32:54-59. [DOI: 10.1016/j.parkreldis.2016.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/27/2016] [Accepted: 08/16/2016] [Indexed: 11/21/2022]
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Matsumoto S, Murakami N, Koizumi H, Takahashi M, Izumi Y, Kaji R. Edrophonium Challenge Test for Blepharospasm. Front Neurosci 2016; 10:226. [PMID: 27375406 PMCID: PMC4894005 DOI: 10.3389/fnins.2016.00226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/06/2016] [Indexed: 11/21/2022] Open
Abstract
Background: Blepharospasm is typically diagnosed by excluding any secondary diseases and neuropsychiatric disorders, as specific tests for blepharospasm are currently unavailable. Since anticholinergic agents are used to improve the symptoms of dystonia, we hypothesized that edrophonium chloride, an acetylcholinesterase inhibitor, may make the symptoms of dystonia more apparent. Therefore, we examined whether an edrophonium challenge test would be useful for diagnosing blepharospasm. Methods: We studied 10 patients with blepharospasm and 10 with hemifacial spasms (as disease controls). We administered edrophonium and saline in this double-blind study. Before and after the injection, we recorded the clinical signs using a video camera to assess the objective symptoms every 2 min. Ten minutes after the isotonic sodium chloride and edrophonium injections, the patients evaluated their subjective signs using a visual analog scale (VAS). The objective signs on the video recordings were scored by specialists who were blind to the treatment. Results: The subjective and objective signs of the patients with blepharospasm were amplified by edrophonium. In contrast, the signs in patients with hemifacial spasms were not changed by the edrophonium challenge test. Conclusions: The edrophonium challenge test may be used to diagnose blepharospasm. The study was registered with a ICMJE recognized registry, the UMIN-CTR, with the number UMIN000022557.
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Affiliation(s)
| | - Nagahisa Murakami
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School Tokushima, Japan
| | - Hidetaka Koizumi
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School Tokushima, Japan
| | | | - Yuishin Izumi
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School Tokushima, Japan
| | - Ryuji Kaji
- Department of Clinical Neuroscience, Institute of Health Biosciences, The University of Tokushima Graduate School Tokushima, Japan
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Dou NN, Zhong J, Liu MX, Xia L, Sun H, Li B, Li ST. Teflon Might Be a Factor Accounting for a Failed Microvascular Decompression in Hemifacial Spasm: A Technical Note. Stereotact Funct Neurosurg 2016; 94:154-8. [PMID: 27251374 DOI: 10.1159/000446192] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/14/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although Teflon is widely adopted for microvascular decompression (MVD) surgery, it has never been addressed for failure analysis. This study analyzed the reasons for failed MVDs with emphasis on the Teflon sponge. METHODS Among the 685 hemifacial spasm cases between 2010 and 2014, 31 were reoperated on within a week because of unsatisfactory outcome, which was focused on in this study. Intraoperative findings regarding Teflon inserts of these repeat MVDs were reviewed. RESULTS Among the 38 without satisfactory outcomes, 31 underwent repeat MVDs, and they were all spasm free afterwards. Eventually, the final cure rate was 99.2%. It was found in the repeat MVDs that the failure was attributable to the Teflon insert in most of the cases (74.2%) directly or indirectly. It was caused by improper placement (47.8%), inappropriate size (34.8%) and unsuitable shape (17.4%) of the Teflon sponge. CONCLUSION Although it is not difficult for an experienced neurosurgeon to discover a neurovascular conflict during the MVD process, the size, shape and location of the Teflon sponge should not be ignored. Basically, the Teflon insert is used to keep the offending artery away from the facial nerve root rather than to isolate it. Therefore, the ideal Teflon sponge should be just small enough to produce a neurovascular separation.
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Affiliation(s)
- Ning-Ning Dou
- Department of Neurosurgery, Xin Hua Hospital, Cranial Nerve Disease Center of Shanghai, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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