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Acevedo-González JC, Taub-Krivoy A, Sierra-Peña JA, Lizarazo JG. Determining prognostic factors in the treatment of primary hemifacial spasm: Clinical outcomes and complications. A literature review. World Neurosurg X 2025; 25:100406. [PMID: 39411270 PMCID: PMC11474211 DOI: 10.1016/j.wnsx.2024.100406] [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: 12/25/2023] [Accepted: 09/20/2024] [Indexed: 10/19/2024] Open
Abstract
Objective Primary Hemifacial Spasm (PHFS) significantly impacts quality of life, necessitating effective treatment like microvascular decompression of the facial nerve. This study aims to identify prognostic factors related to surgical treatment to enhance outcomes and minimize complications. A systematic review of literature from the past five years was conducted. Methods Following PRISMA guidelines, we systematically searched databases like PubMed, Embase, Scopus, Ovid, EBSCO, and Cochrane using keywords such as 'Hemifacial spasm,' 'Microvascular decompression,' 'Neurovascular conflict,' and 'Surgical techniques.' The search spanned January 2018 to November 2023. The 'Rayyan' program facilitated data compilation. Each author reviewed abstracts, applying inclusion criteria like systematic reviews, clinical trials, observational studies, and case series, while excluding theoretical or non-English articles. Results Of 26 selected articles, those solely addressing PHFS treatment with botulinum toxin and lacking surgical procedure data were excluded. Thus, our analysis focused on 16 articles, including meta-analyses, systematic reviews, clinical trials, and observational studies. Discussion Microvascular decompression at the cerebellar pontine angle is the mainstay treatment for hemifacial spasm. Despite limited statistically significant prognostic factors in the literature, overarching recommendations aim to improve outcomes, minimize complications, and prevent recurrences. Key considerations include surgeon expertise, precise techniques, thorough nerve exploration, identifying the conflict's cause, and intraoperative monitoring. Conclusions PHFS significantly impacts patients' lives, necessitating timely surgical intervention if initial treatments fail. While statistically significant prognostic factors may be lacking, this study highlights crucial considerations for successful treatment.
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Affiliation(s)
- Juan Carlos Acevedo-González
- Neurosurgeon Specialized in Functional Neurosurgery and Stereotaxic Surgery, Pain, and Spasticity Management, Full Professor at the Faculty of Medicine, Pontifical Javeriana University, San Ignacio University Hospital, Bogotá, Colombia
| | - Alex Taub-Krivoy
- Coordinator of the Research Group in Neurosurgery, Pontifical Javeriana University, Bogotá, Colombia
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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; 45:4857-4861. [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] [MESH Headings] [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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Ardisana EF, Villalonga JF, Suárez MM, Campero A. Hemifacial spasm associated with trigeminal neuralgia secondary to trigeminal vascular compression. NEUROCIRUGIA (ENGLISH EDITION) 2024:S2529-8496(24)00039-X. [PMID: 39074661 DOI: 10.1016/j.neucie.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 07/06/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024]
Abstract
The coincidence in a patient of Hemifacial Spasm and Trigeminal Neuralgia is not frequent. A case is presented with the objective of showing this association due to the abnormal activation of the Trigemino-Facial Reflex. A 55-year-old woman with an 8-year history of left-sided hemifacial spasm and typical trigeminal pain in the ipsilateral V1 and V2 territory. The physical examination shows spasms in the left hemiface, with reproduction of intense pain upon sensory stimulation of the skin on the forehead and upper dental arch. The MRI showed a vessel in intimate contact with the entrance area of the left trigeminal nerve. A left retrosigmoid approach was performed. First, the entrance area of the trigeminal nerve was accessed, finding a clear vascular conflict, which was isolated with Teflon. Then, the trajectory was changed and the exit zone of the facial nerve was accessed, and no type of vascular conflict was identified. The patient presented complete resolution of the Hemifacial Spasm and the associated trigeminal pain. The analysis of this case allows us to conclude that during microvascular decompression of the Facial Nerve, if frank proximal compression is not evident, the Trigeminofacial structural relationship must be taken into account, making it necessary to explore the Trigeminal Nerve.
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Affiliation(s)
- Ernesto F Ardisana
- Laboratorio de Innovaciones Neuroquirúrgicas de Tucumán (LINT), Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina.
| | - Juan F Villalonga
- Laboratorio de Innovaciones Neuroquirúrgicas de Tucumán (LINT), Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Mauro M Suárez
- Laboratorio de Innovaciones Neuroquirúrgicas de Tucumán (LINT), Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Alvaro Campero
- Laboratorio de Innovaciones Neuroquirúrgicas de Tucumán (LINT), Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina; Hospital General Angel C. Padilla, Tucumán, Argentina
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Truong VT, Ngo MQ, Phan D, Le H, Tran Hoang NA. Results from 228 Patients with Hemifacial Spasm Undergoing Microvascular Decompression without Intraoperative Neuroelectrophysiology Monitoring. World Neurosurg 2024; 185:e461-e466. [PMID: 38369107 DOI: 10.1016/j.wneu.2024.02.053] [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: 01/30/2024] [Accepted: 02/09/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Intraoperative neuroelectrophysiology monitoring (IONM) has been used to decrease complications and to increase the successful rate of microvascular decompression (MVD) MVD for hemifacial spasm (HFS). Still, it is not available at limited resource centers. We report the outcome of patients undergoing MVD for HFS without using IONM. METHODS The variables concerning the patients' demographics (age and gender), clinical characteristics, offending vessels (vertebral artery type and non-vertebral artery type), postoperative grade of HFS, and postoperative complications of HFS patients undergoing MVD were retrospectively reviewed and collected. The scoring system provided by the Japan Society for MVD was used to evaluate the postoperative outcome of HFS. Postoperative hearing ability was evaluated according to a subjective assessment of the patients. RESULTS A total of 228 patients were recruited. Their median age was 51.0 (44.0-57.0) years old. The total cure effect was observed in 207 (90.8%) patients within the first week after the surgery and in 200 (96.1%) patients in a 2-year follow-up. Permanent hearing disturbance happened in 2 patients (0.9%). No patient had permanent unilateral deafness (0%). No postoperative permanent facial paralysis was reported. CONCLUSIONS MVD without IONM may be performed safely and effectively to treat patients with HFS.
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Affiliation(s)
- Van Tri Truong
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam.
| | - Minh Quan Ngo
- Department of Neurosurgery, Nhan Dan Gia Dinh hospital, Ho Chi Minh City, Vietnam
| | - Duy Phan
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam
| | - Hung Le
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam
| | - Ngoc Anh Tran Hoang
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam
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Onoda K, Sashida R, Fujiwara R, Wakamiya T, Michiwaki Y, Tanaka T, Shimoji K, Suehiro E, Yamane F, Kawashima M, Matsuno A. Intermediate nerve neuralgia developed during hemifacial spasm follow-up: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE22144. [PMID: 35733844 PMCID: PMC9210264 DOI: 10.3171/case22144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intermediate nerve neuralgia (INN) is a rare condition believed to be caused by vascular compression, with external auditory canal pain as the chief symptom. The authors reported a rare case of a 78-year-old woman who developed INN during follow-up for hemifacial spasm (HFS). OBSERVATIONS The patient had been receiving Botox treatment for right HFS for 20 years when she developed paroxysmal electric shock pain in the right external auditory canal and tinnitus induced by opening her mouth. A three-dimensional magnetic resonance fusion image showed the cisternal portion of the facial-vestibulocochlear nerve complex to be compressed by the meatal loop of the anterior inferior cerebellar artery (AICA), which was pressed against by the posterior inferior cerebellar artery. The authors diagnosed INN, and microvascular decompression (MVD) was performed. Surgical findings were consistent with preoperative neuroimaging. In addition, the proximal portion of the meatal loop of the AICA had passed between the facial and vestibulocochlear nerves, compressing both. The AICA was moved and the nerve completely decompressed. All symptoms improved immediately following surgery. LESSONS When INN occurs during HFS follow-up, aggressive MVD should be considered based on detailed neuroimaging. This treatment is a very effective single-stage cure for INN, HFS, and vestibulocochlear symptoms.
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Affiliation(s)
- Keisuke Onoda
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
| | - Ryohei Sashida
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
| | - Ren Fujiwara
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
| | - Tomihiro Wakamiya
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
| | - Yuhei Michiwaki
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
| | - Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
| | - Kazuaki Shimoji
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
| | - Eiichi Suehiro
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
| | - Fumitaka Yamane
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
| | - Masatou Kawashima
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
| | - Akira Matsuno
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan
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Xu S, Liu X, Zhao W, Ma Y, Du X, Huang B. Extracranial Radiofrequency Treatment for Painful Tic Convulsif Syndrome Under Local Anesthesia. Pain Ther 2022; 11:723-729. [PMID: 35438464 PMCID: PMC9098771 DOI: 10.1007/s40122-022-00377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Painful tic convulsif syndrome is ipsilateral facial trigeminal neuralgia combined with hemifacial spasm, which is relatively rare in the clinic. Microvascular decompression is currently considered to be an effective treatment. We report extracranial radiofrequency treatment of painful tic convulsif syndrome under local anesthesia, a technique which provides a safer and more economical treatment for this kind of patient. Case Presentation We report a case of painful tic convulsif syndrome which was treated with extracranial radiofrequency therapy of the trigeminal nerve and facial nerve. After operations, the symptoms of pain and spasm were relieved immediately, but the right facial numbness and facial paralysis (House–Brackmann grade III) were left. The facial paralysis was completely relieved after 3 months of follow-up, and there was no recurrence of trigeminal neuralgia or hemifacial spasm after 35 months. Discussion Painful tic convulsif syndrome is a combination of ipsilateral facial trigeminal neuralgia and hemifacial spasm, which is relatively rare in the clinic. So far, only one treatment method of microvascular decompression has been reported for the disease. We report the first case of CT-guided extracranial radiofrequency therapy for painful tic convulsif syndrome. Conclusion Extracranial radiofrequency therapy can provide safe and economical treatment for patients with painful tic convulsif syndrome.
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Affiliation(s)
- Shuangshuang Xu
- The Affiliated Hospital of Jiaxing University/The First Hospital of Jiaxing, No. 1882 South Zhonghuan Road, Nanhu District, Jiaxing City, Zhejiang, China
| | - Xiaolan Liu
- The Affiliated Hospital of Jiaxing University/The First Hospital of Jiaxing, No. 1882 South Zhonghuan Road, Nanhu District, Jiaxing City, Zhejiang, China
| | - Wei Zhao
- The Affiliated Hospital of Jiaxing University/The First Hospital of Jiaxing, No. 1882 South Zhonghuan Road, Nanhu District, Jiaxing City, Zhejiang, China
| | - Ying Ma
- The Affiliated Hospital of Jiaxing University/The First Hospital of Jiaxing, No. 1882 South Zhonghuan Road, Nanhu District, Jiaxing City, Zhejiang, China
| | - Xindan Du
- Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Bing Huang
- The Affiliated Hospital of Jiaxing University/The First Hospital of Jiaxing, No. 1882 South Zhonghuan Road, Nanhu District, Jiaxing City, Zhejiang, China.
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Inoue T, Shitara S, Goto Y, Arham A, Prasetya M, Radcliffe L, Fukushima T. Bridge technique for hemifacial spasm with vertebral artery involvement. Acta Neurochir (Wien) 2021; 163:3311-3320. [PMID: 34613530 PMCID: PMC8599217 DOI: 10.1007/s00701-021-05006-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To assess efficacy and safety of a newly developed decompression technique in microvascular decompression for hemifacial spasm (HFS) with vertebral artery (VA) involvement. METHODS A rigid Teflon (Bard® PTFE Felt Pledget, USA) with the ends placed between the lower pons and the flocculus creates a free space over the root exit zone (REZ) of the facial nerve (bridge technique). The bridge technique and the conventional sling technique for VA-related neurovascular compression were compared retrospectively in 60 patients. Elapsed time for decompression, number of Teflon pieces used during the procedure, and incidences of intraoperative manipulation to the lower cranial nerves were investigated. Postoperative outcomes and complications were retrospectively compared in both techniques. RESULTS The time from recognition of the REZ to completion of the decompression maneuvers was significantly shorter, and fewer Teflon pieces were required in the bridge technique than in the sling technique. Lower cranial nerve manipulations were performed less in the bridge technique. Although statistical analyses revealed no significant differences in surgical outcomes except spasm-free at postoperative 1 month, the bridge technique is confirmed to provide spasm-free outcomes in the long-term without notable complications. CONCLUSIONS The bridge technique is a safe and effective decompression method for VA-involved HFS.
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Affiliation(s)
- Takuro Inoue
- Department of Neurosurgery, Subarukai Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan.
| | - Satoshi Shitara
- Department of Neurosurgery, Subarukai Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan
| | - Yukihiro Goto
- Department of Neurosurgery, Subarukai Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan
| | - Abrar Arham
- Department of Neurosurgery, Indonesia National Brain Center Hospital, East Jakarta, Special Capital Region of Jakarta, Indonesia
| | - Mustaqim Prasetya
- Department of Neurosurgery, Indonesia National Brain Center Hospital, East Jakarta, Special Capital Region of Jakarta, Indonesia
| | | | - Takanori Fukushima
- Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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Yin Z, Liu Y, Bai Y, Zhang H, Yao W, Yu F, Zhang J, Liu R, Yang A. The Epidemiology, Cause, and Prognosis of Painful Tic Convulsif Syndrome: An Individual Patient Data Analysis of 192 Cases. World Neurosurg 2020; 147:e130-e147. [PMID: 33307261 DOI: 10.1016/j.wneu.2020.11.161] [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: 10/26/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Characterized by the coexistence of trigeminal neuralgia and ipsilateral hemifacial spasm (HFS), painful tic convulsif (PTC) is a rare entity that has not yet been systematically studied. OBJECTIVE To systematically explore the epidemiology, cause, prognosis, and prognosis predictors of PTC. METHODS We searched PubMed, Web of Science, and the Cochrane Library for relevant studies published between establishment of the library and July 1, 2020. Information on demographics, causes, specific interventions, and intervention outcomes was extracted. We first performed descriptive analysis of demographics, causes, and surgical outcomes of PTC. Univariate and multivariate regression methods were used to explore potential prognosis predictors. Further, a 2-step meta-analysis method was used to validate the identified factors. RESULTS Overall, 57 reports including 192 cases with PTC were included in the analysis. The median age of patients with PTC is 54 years (range, 44-62 years), with more patients being female (P < 0.001), initiated as HFS (P = 0.005), and being affected with left side (P = 0.045). The vertebrobasilar artery contributes to >65% of the causes of single vascular compression for PTC. Anterior inferior cerebellar artery/posterior inferior cerebellar artery involvement (odds ratio, 4.050; 95% confidence interval, 1.091-15.031) and older age (P = 0.008) predict freedom from symptoms and recurrence after microvascular decompression, respectively. CONCLUSIONS PTC occurs more in middle-aged women between 40 and 60 years old, initiates as HFS, and affects the left side. Vertebrobasilar artery compression is the most common single cause of PTC. Microvascular decompression effectively treated PTC, with a cure rate >80%. Anterior inferior cerebellar artery/posterior inferior cerebellar artery involvement predicts successful surgery and older age predicts recurrence.
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Affiliation(s)
- Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuye Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hua Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Yao
- Department of Neurosurgery, Shunping County Hospital, Baoding, Hebei Province, China
| | - Feng Yu
- Department of Neurosurgery, PLA 960th Hospital, Jinan, Shandong Province, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Ruen Liu
- Peking University People's Hospital, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Honey CM, Krüger MT, Rheaume AR, Avecillas-Chasin JM, Morrison MD, Honey CR. Concurrent Glossopharyngeal Neuralgia and Hemi-Laryngopharyngeal Spasm (HeLPS): A Case Report and a Review of the Literature. Neurosurgery 2020; 87:E573-E577. [PMID: 31832655 PMCID: PMC8133322 DOI: 10.1093/neuros/nyz546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/24/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Hemi-laryngopharyngeal spasm (HeLPS) has been recently described but is not yet widely recognized. Patients describe intermittent coughing and choking and can be cured following microvascular decompression of their Xth cranial nerve. This case report and literature review highlight that HeLPS can co-occur with glossopharyngeal neuralgia (GN) and has been previously described (but not recognized) in the neurosurgical literature. CLINICAL PRESENTATION A patient with GN and additional symptoms compatible with HeLPS is presented. The patient reported left-sided, intermittent, swallow-induced, severe electrical pain radiating from her ear to her throat (GN). She also reported intermittent severe coughing, throat contractions causing a sense of suffocation, and dysphonia (HeLPS). All her symptoms resolved following a left microvascular decompression of a loop of the posterior inferior cerebellar artery that was pulsating against both the IXth and Xth cranial nerves. A review of the senior author's database revealed another patient with this combination of symptoms. An international literature review found 27 patients have been previously described with symptoms of GN and the additional (but not recognized at the time) symptoms of HeLPS. CONCLUSION This review highlights that patients with symptoms compatible with HeLPS have been reported since 1926 in at least 4 languages. This additional evidence supports the growing recognition that HeLPS is another neurovascular compression syndrome. Patients with HeLPS continue to be misdiagnosed as conversion disorder. The increased recognition of this new medical condition will require neurosurgical treatment and should alleviate the suffering of these patients.
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Affiliation(s)
- C Michael Honey
- Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marie T Krüger
- Division of Neurosurgery, University of British Columbia, Vancouver, Canada
| | - Alan R Rheaume
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Murray D Morrison
- Division of Otolaryngology, University of British Columbia, Vancouver, Canada
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