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Cao C, Li M, Wu M, Jiang X. Hemifacial Spasm Associated With the Specific Offending Vein. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01251. [PMID: 38995027 DOI: 10.1227/ons.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/29/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Hemifacial spasm (HFS) caused by venous compression is a rare occurrence. Currently, there is no relevant research on the venous characteristics and potential pathogenic mechanisms causing venous HFS. Exploring the venous characteristics in venous-type HFS may reduce the likelihood of repeated surgery. METHODS The authors presented 4 cases of HFS caused by veins of middle cerebellar peduncle (V. of Mid.Cer.Ped) successfully treated with microvascular decompression. RESULTS Based on intraoperative observations and abnormal muscle response (AMR) monitoring, it was determined that V. of Mid.Cer.Ped were offending vessels in these patients. Moreover, veins crossed between the facial and vestibulocochlear nerves, and then surrounded the ventral aspect of the facial nerve root. Microvascular decompression for the offending vessel was successfully performed, and AMR disappeared for each patient. These patients were discharged without any complications and involuntary contractions or twitching of facial muscles. CONCLUSION The study demonstrated that veins can indeed induce HFS. The characteristic of the V. of Mid.Cer.Ped that leads to HFS is that these veins traverse between the facial nerve and the vestibulocochlear nerve, and then surround the ventral aspect of the facial nerve root. The dynamic influence of cerebrospinal fluid leads to pulsatile impingement of the facial nerve on the vein, resulting in facial nerve bending and deformation at the location of the vein. Significantly, in the context of surgery, if it is noticed that the V. of Mid.Cer.Ped surrounds the ventral aspect of the facial nerve root and the facial nerve is compressed and deformed, when AMR disappears after decompression of the artery, it may be necessary to perform vein decompression.
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Affiliation(s)
- Chenglong Cao
- Department of Neurosurgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui Province, People's Republic of China
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Zhang J, Wang S, Jiang Y, Zhang Y. Oculomotor Nerve Palsy Induced by a Cerebral Developmental Venous Anomaly: A Case Report and Comprehensive Review. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943363. [PMID: 38762752 PMCID: PMC11117436 DOI: 10.12659/ajcr.943363] [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: 12/02/2023] [Revised: 04/02/2024] [Accepted: 03/18/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Symptoms caused by developmental venous anomalies (DVAs) are usually mild and unspecific. Despite the benign nature of DVAs, they can occasionally be symptomatic. CASE REPORT A 67-year-old woman presented with sudden diplopia and left eyelid ptosis for 10 days. A neurologic examination revealed left complete oculomotor nerve palsy. Other neurologic deficits, including eye pain or pulsatile tinnitus, were not detected. Furthermore, the visual acuity was normal. Additionally, no retinal hemorrhage, venous dilatation, or fundus tortuosity were observed. No ischemia lesions or neoplasms were observed in MRI, and no widening or enhancement of the cavernous sinus was detected in post-contrast T1-weighted images, but magnetic resonance tomography cerebral angiography (MRTA) detected an offending vessel compressing the left oculomotor nerve in the fossa interpeduncular. We hypothesized that oculomotor nerve palsy (ONP) was caused by an abnormal arterial structure. However, digital subtraction angiography (DSA) revealed no aneurysm or abnormal arterial structure in the arterial phase, while a tortuous and dilated collecting vein was detected in the venous phase, connecting the left temporal lobe to the left cavernous sinus. This indicated a typical caput medusae appearance, suggesting the mechanism of oculomotor palsy caused by compressive impairment of the DVA. The patient refused microvascular decompression surgery, and ONP persisted after 30 days. Management was conservative, with spontaneous resolution at 60 days and no recurrence during the 2-year follow-up. CONCLUSIONS ONP is rarely caused by DVAs, which are easily ignored due to their benign nature. Cerebral vein examinations are advised for patients exhibiting clinical symptoms of unknown etiology.
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Affiliation(s)
- Jianying Zhang
- Department of Neurology, Shanghai Pudong New Area People’s Hospital, Shanghai, PR China
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Sisi Wang
- Department of Neurology, Shanghai Pudong New Area People’s Hospital, Shanghai, PR China
| | - Ying Jiang
- Department of Neurology, Changzhou First People’s Hospital, Changzhou, Jiangsu, PR China
| | - Yue Zhang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, PR China
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He F, Luo X, Meng F, Chen J, Liang C, Zhang Y, Liu S, Yuan Z, Zhang W, He Y, Zhang J. Subcutaneous injection of hyaluronic acid leading to emboliom and recanalization process monitored in real time by three-dimensional photoacoustic imaging. Heliyon 2024; 10:e25066. [PMID: 38314292 PMCID: PMC10837626 DOI: 10.1016/j.heliyon.2024.e25066] [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: 08/16/2023] [Revised: 12/06/2023] [Accepted: 01/19/2024] [Indexed: 02/06/2024] Open
Abstract
This study describes a method for real-time examination of the microvascular system based on the three-dimensional photoacoustic imaging system to prevent arterial complications, especially vascular embolism, during hyaluronic acid (HA) injections. Chicken embryos were used to simulate the superficial blood vessels of human skin, and then the target area was imaged by the photoacoustic imaging system for three-dimensional vascular imaging, and then the syringe and blood vessels were monitored, and the syringe angle and penetration depth were adjusted in time using an injection device to avoid puncturing the arterial vasculature and clogging the blood vessels. HA was then injected into smaller vessels on the dorsum of the tongue in mice and into thicker vessels on the dorsal portion of the tongue in rats to mimic embolization, and the post-operative recovery was reflected by the changes in the pixel dots of the extracted part of the blocked blood vessels, and it was observed that the blood flow in the area of the fine vessels was restored in about 3 days, whereas blood flow in the area of the large vessels was restored in only about 1 h. The method presented in this paper allows precise guidance of injectable filler HA, which has good application prospects in improving the safety of injection micro-plastic surgery and reducing the experience requirements for medical personnel.
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Affiliation(s)
- Fengbing He
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Xingzhi Luo
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
| | - Fan Meng
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Jiarui Chen
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Chaohao Liang
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Yiqing Zhang
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Shutong Liu
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Zishan Yuan
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Wuyu Zhang
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
| | - Yanping He
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
| | - Jian Zhang
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, School of Biomedical Engineering, Guangzhou Medical University, Guangdong, China
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Tugend M, Sekula RF. Microvascular decompression for developmental venous anomaly causing hemifacial spasm: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23479. [PMID: 38163344 PMCID: PMC10763632 DOI: 10.3171/case23479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Developmental venous anomaly (DVA) is a rare cause of hemifacial spasm (HFS). The treatment of HFS caused by a DVA varies in the literature and includes medication management, botulinum toxin injections, and microvascular decompression (MVD). OBSERVATIONS A 64-year-old woman presented with right-sided HFS. Preoperative magnetic resonance imaging showed a DVA in the right inferior pons, with an enlarged segment compressing the facial nerve at its root detachment point prior to drainage into the superior petrosal sinus. MVD was performed, and the facial nerve was decompressed without sacrifice of the vein. Immediately following the procedure, the patient had significantly reduced spasms. The patient became spasm-free 3 months after MVD and maintained spasm freedom for 3 months. Six months after MVD, the patient had a partial return of spasms. At 8 months, the patient continued to have reduced and intermittent spasms in the right orbicularis oculi muscle. LESSONS MVD for HFS caused by a DVA is a safe procedure and can be effective at reducing spasm frequency and severity.
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Grigoryan GY, Dzhindzhikhadze RS, Shumovsky VK, Grigoryan YA. [Interposition and transposition techniques of vascular decompression for hemifacial spasm]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:30-40. [PMID: 37011326 DOI: 10.17116/neiro20238702130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To analyze the vessels compressing facial nerve root exit zone and efficacy of interposition and transposition techniques of vascular decompression for hemifacial spasm. MATERIAL AND METHODS Vascular compression was evaluated in 110 patients. Implant interposition between vessels and nerve was performed in 52 cases, transposition of arteries without contact between implants and nerve - in 58 patients. RESULTS Compressing vessels were anterior (44), posterior (61) inferior cerebellar, vertebral (28) arteries and veins (4). Multiple compressing vessels were found in 27 cases. Premeatal meningioma and jugular schwannoma were accompanied by vascular compression in 2 cases. Immediate regression of symptoms was observed in 104 patients, partial regression - in 6 patients. Transient facial paresis (4) and impaired hearing (5) were noted after implant interposition. Redo vascular decompression was performed in one case. CONCLUSION The most common compressing vessels were cerebellar arteries, vertebral artery and veins. Transposition of arteries is highly effective technique with low incidence of VII-VII nerve dysfunction but relatively slow regression of symptoms.
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Affiliation(s)
- G Yu Grigoryan
- Moscow Regional Research Clinical Institute, Moscow, Russia
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Brainstem lesions: MRI review of standard morphological sequences. Acta Neurol Belg 2022; 122:597-613. [PMID: 35428930 DOI: 10.1007/s13760-022-01943-y] [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: 07/29/2021] [Accepted: 03/23/2022] [Indexed: 11/01/2022]
Abstract
MRI signal changes in the brainstem are observed in a multitude of disorders including vascular diseases, neoplastic lesions, degenerative diseases, inflammatory disorders, metabolic diseases, infections, and trauma. In some diseases, brainstem involvement is typical and sometimes isolated, while in other diseases, brainstem lesions are only observed occasionally in the presence of other typical extra-brainstem abnormalities. In this review, we will discuss the MRI characteristics of brainstem lesions observed in different disorders associated with frequent and less frequent brainstem involvement. Identification of the origin of the brainstem lesion depends on the exact localisation of the lesion(s) inside the brainstem, the presence and the characteristics of associated lesions seen outside the brainstem, the signal changes on different MRI sequences, the evolution over time of the radiological abnormalities, the history and clinical state of the patient, and other radiological and non-radiological examinations.
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Cerebral venous thrombosis: an unexpected Brissaud-Sicard syndrome mimicker. Neurol Sci 2022; 43:3439-3441. [PMID: 35286541 PMCID: PMC8919905 DOI: 10.1007/s10072-022-05977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 11/23/2022]
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