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Neuro-Chirurgie May 2018Primary hemifacial spasm with few exceptions is due to the vascular compression of the facial nerve that can be evidenced with high resolution MRI. Microvascular... (Review)
Review
Primary hemifacial spasm with few exceptions is due to the vascular compression of the facial nerve that can be evidenced with high resolution MRI. Microvascular decompression is the only curative treatment for this pathology. According to literature review detailed in chapter "conflicting vessels", the compression is located at the facial Root Exit Zone (REZ) in 95% of the cases, and in 5% distally at the cisternal or the intrameatal portion of the root as the sole conflict or in addition to one at brainstem/REZ. Therefore, exploration has to be performed on the entire root, from the ponto-medullary fissure to the internal auditory meatus. Because microvascular decompression is functional surgery, the procedure should be as harmless as possible and with a high probability of permanent efficacy. Besides facial palsy, main complications are hearing loss, tinnitus and gait disturbances. Causes are cochlea/labyrinth ischemia due to manipulations of their nutrient arteries and/or stretching of the eight nerve complex. To minimize the latter, the approach should not be with lateral-to-medial retraction of the cerebellar hemisphere, but along an infra-floccular trajectory, from below. In fact, most of the neurovascular conflicts are situated ventro-caudally to facial REZ at the brainstem, particularly those from a megadolicho-vertebrobasilar artery and its posterior inferior-cerebellar branch. Also, care should be taken not to cause any injury of the manipulated vessels or stretching of their perforators to brainstem. Heating from bipolar coagulation must be avoided. The inserted material used to maintain the offending vessel(s) away must not be neo-compressive. Intraoperative neuromonitoring is considered to be useful for achieving safe surgery at least until the learning curve has reached an optimal level, particularly BrainstemAuditory Evoked Potentials recordings. Increase in latency and/or decrease in amplitude of wave V warn excessive stretching or damage to the cochlear nerve, and decrease in amplitude of wave I signals possible ischemia of the cochlea. Free-running EMG of the facial muscles may warn against excessive manipulation of the facial nerve. Recording of the lateral spread responses - which are a sign of hyperexcitabilty of the facial motor system - may provide information on completeness of the decompression.
Topics: Facial Muscles; Facial Nerve; Hemifacial Spasm; Humans; Microvascular Decompression Surgery; Monitoring, Intraoperative; Neurosurgical Procedures
PubMed: 29784430
DOI: 10.1016/j.neuchi.2018.04.003 -
Toxins Dec 2021Hemifacial spasm (HFS) is a movement disorder characterized by involuntary contractions of the facial muscles innervated by the seventh cranial nerve. Generally, it is... (Review)
Review
UNLABELLED
Hemifacial spasm (HFS) is a movement disorder characterized by involuntary contractions of the facial muscles innervated by the seventh cranial nerve. Generally, it is associated with a poor quality of life due to social embarrassment and can lead to functional blindness. Moreover, it is a chronic condition, and spontaneous recovery is rare. Intramuscular injections of Botulinum Toxin (BoNT) are routinely used as HFS treatment.
METHODS
We reviewed published articles between 1991 and 2021 regarding the effectiveness and safety of BoNT in HFS as well as any reported differences among BoNT formulations.
RESULTS
The efficacy of BoNT for HFS treatment ranged from 73% to 98.4%. The mean duration of the effect was around 12 weeks. Effectiveness did not decrease over time. Adverse effects were usually mild and transient. The efficacy and tolerability of the different preparations appeared to be similar. Among the studies, dosage, injected muscles, intervals of treatment, and rating scales were variable, thus leading to challenges in comparing the results.
CONCLUSIONS
BoNT was the treatment of choice for HFS due to its efficacy and safety profile. Further studies are needed to investigate the factors that influence the outcome, including the optimal timing of treatment, injection techniques, dosage, and the best selection criteria for formulations.
Topics: Botulinum Toxins, Type A; Hemifacial Spasm; Humans; Injections, Intramuscular; Neuromuscular Agents; Practice Guidelines as Topic
PubMed: 34941718
DOI: 10.3390/toxins13120881 -
TheScientificWorldJournal 2014Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the... (Review)
Review
Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Its prevalence is 9.8 per 100,000 persons with an average age of onset of 44 years. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone of the facial nerve. HFS can be divided into two types: primary and secondary. Primary HFS is triggered by vascular compression whereas secondary HFS comprises all other causes of facial nerve damage. Clinical examination and imaging modalities such as electromyography (EMG) and magnetic resonance imaging (MRI) are useful to differentiate HFS from other facial movement disorders and for intraoperative planning. The standard medical management for HFS is botulinum neurotoxin (BoNT) injections, which provides low-risk but limited symptomatic relief. The only curative treatment for HFS is microvascular decompression (MVD), a surgical intervention that provides lasting symptomatic relief by reducing compression of the facial nerve root. With a low rate of complications such as hearing loss, MVD remains the treatment of choice for HFS patients as intraoperative technique and monitoring continue to improve.
Topics: Adult; Age of Onset; Botulinum Toxins, Type A; Decompression, Surgical; Electromyography; Facial Nerve; Female; Hemifacial Spasm; Humans; Magnetic Resonance Imaging; Male; Microsurgery; Middle Aged; Nerve Compression Syndromes; Neuromuscular Agents
PubMed: 25405219
DOI: 10.1155/2014/349319 -
Neurology India 2020Facial spasms are of various types. Hemifacial spasm (HFS) is characterized by unilateral tonic-clonic contractions of facial muscles, following a specific pattern of... (Review)
Review
Facial spasms are of various types. Hemifacial spasm (HFS) is characterized by unilateral tonic-clonic contractions of facial muscles, following a specific pattern of disease progression. It has well-delineated clinical, radiological and electrophysiological features. We have conducted an extensive review of existing literature on the subject, as regards etiopathogenesis, clinical features, investigations and management options for facial spasms. Primary Hemifacial spasm (HFS) may be treated using pharmacotherapy, botulinum toxin injections or microvascular decompression surgery. Microvascular decompression has the potential to reverse the pathological changes of the disease and has proved to be the most successful of all treatment options. Other facial spasms are exceedingly difficult to treat and may need neuromodulation as an option. The following article attempts to review the clinical features and therapeutic approaches to managing patients with facial spasms.
Topics: Facial Muscles; Facial Nerve Diseases; Hemifacial Spasm; Humans; Microsurgery; Microvascular Decompression Surgery; Spasm
PubMed: 33318350
DOI: 10.4103/0028-3886.302455 -
Asian Journal of Neurosurgery 2020Hemifacial spasm (HFS) is a condition, characterized by painless, involuntary unilateral tonic or clonic contractions of the facial muscles innervated by the ipsilateral... (Review)
Review
INTRODUCTION AND OBJECTIVE
Hemifacial spasm (HFS) is a condition, characterized by painless, involuntary unilateral tonic or clonic contractions of the facial muscles innervated by the ipsilateral facial nerve. HFS starts with contractions in the orbicularis oculi muscle with subsequent eyelid closure and/or eyebrow elevation, but may spread to involve muscles of the frontalis, platysma, and orbicularis oris muscles. Microvascular decompression (MVD) is reliable and accepted surgical treatment for HFS. MVD is the standard surgical technique now for HFS treatment with long-term success rates.
MATERIALS AND METHODS
We performed fully endoscopic MVD technique for 1 patient with HFS (a 83-year-old female) at our institution. HFS was diagnosed based on the clinical history and presentation, a neurologic examination, and additional imaging findings. Respectively, the durations of HFS were 3 years, respectively. The patient had been previously treated with repeated botulinum toxin injections. Preoperative evaluation was done with magnetic resonance imaging; three-dimensional computed tomography fusion images examinations had identified the anterior inferior cerebellar artery (AICA) as the offending vessel in this patient.
RESULTS
The patient with HFS was treated by fully endoscopic MVD technique. The AICA, which had been identified as the offending vessel by preoperative magnetic resonance imaging, was successfully decompressed. No surgery-related complications occurred and had excellent outcomes with the complete resolution of HFS immediately after the operation.
CONCLUSIONS
Endoscopic surgery can provide a more panoramic surgical view than conventional microscopic surgery. Fully endoscopic MVD is both safe and effective in the treatment of HFS. This method minimizes the risks of brain retraction and extensive dissection often required for microscopic exposure. Endoscopic MVD is safe and has advantage over microscope in terms of visualization of structure, identification of neurovascular conflict, but it has a learning curve and technically challenging.
PubMed: 33708651
DOI: 10.4103/ajns.AJNS_152_20 -
Journal of Neurology, Neurosurgery, and... Feb 1999
Topics: Hemifacial Spasm; Humans; Magnetic Resonance Imaging
PubMed: 10071121
DOI: 10.1136/jnnp.66.2.255a -
Brain : a Journal of Neurology Jun 2021Hemifacial spasm is typically caused by vascular compression of the proximal intracranial facial nerve. Although the prevalence of neurovascular compression has been...
Hemifacial spasm is typically caused by vascular compression of the proximal intracranial facial nerve. Although the prevalence of neurovascular compression has been investigated in a cohort of patients with classical trigeminal neuralgia, the prevalence and severity of neurovascular compression has not been well characterized in patients with hemifacial spasm. We aimed to investigate whether presence and severity of neurovascular compression are correlated to the symptomatic side in patients with hemifacial spasm. All patients in our study were evaluated by a physician who specializes in the management of cranial nerve disorders. Once hemifacial spasm was diagnosed on physical exam, the patient underwent a dedicated cranial nerve protocol magnetic resonance imaging study on a 3 T scanner. Exams were retrospectively reviewed by a neuroradiologist blinded to the symptomatic side. The presence, severity, vessel type, and location of neurovascular compression along the facial nerve was recorded. Neurovascular compression was graded as contact alone (vessel touching the facial nerve) versus deformity (indentation or deviation of the nerve by the culprit vessel). A total of 330 patients with hemifacial spasm were included. The majority (232) were female while the minority (98) were male. The average age was 55.7 years. Neurovascular compression (arterial) was identified on both the symptomatic (97.88%) and asymptomatic sides (38.79%) frequently. Neurovascular compression from an artery along the susceptible/proximal portion of the nerve was much more common on the symptomatic side (96.36%) than on the asymptomatic side (12.73%), odds ratio = 93.00, P < 0.0001. When we assessed severity of arterial compression, the more severe form of neurovascular compression, deformity, was noted on the symptomatic side (70.3%) much more frequently than on the asymptomatic side (1.82%) (odds ratio = 114.00 P < 0.0001). We conclude that neurovascular compression that results in deformity of the susceptible portion of the facial nerve is highly associated with the symptomatic side in hemifacial spasm.
Topics: Adult; Aged; Arteries; Facial Nerve; Female; Hemifacial Spasm; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nerve Compression Syndromes; Prevalence; Retrospective Studies
PubMed: 33842948
DOI: 10.1093/brain/awab030 -
Journal of the Neurological Sciences Mar 2023Hemifacial spasm (HFS) is a movement disorder of facial muscles innervated by the facial nerve. This condition often demands regular utilization of healthcare resources....
BACKGROUND
Hemifacial spasm (HFS) is a movement disorder of facial muscles innervated by the facial nerve. This condition often demands regular utilization of healthcare resources. However, knowledge of the incidence and prevalence of this condition is based on scarce studies. This research aimed to identify the incidence and prevalence of HFS in Finland's largest hospital district.
METHODS
This retrospective study was conducted in the largest hospital district in Finland (Helsinki and Uusimaa). The study included consecutive HFS patients who visited the departments of Neurology and Neurosurgery in the Hospital District of Helsinki and Uusimaa between 2014 and 2019. The demographics included sex, side of the spasm, treatment allocations, duration of symptoms before diagnosis, and age at the time of diagnosis.
RESULTS
279 patients were identified from the medical records. 62% of patients were women and had left-sided spasms. The crude mean incidence among women was almost double that of men (1.86 vs. 0.94). The highest crude mean annual incidence among men was in the age group 60-79 years, while among women, it peaked in the age group 80 years and over. The mean annual age-standardized incidence of HFS was 1.53, 1.94 in women, and 1.05 in men. The mean age-standardized yearly prevalence was 10.62, 11.62 among women, and 9.31 among men. The annual age-standardized prevalence of HFS increased steadily from 2014 to 2019.
CONCLUSIONS
The incidence and prevalence of women outnumbered men. HFS is typically left-sided. The HFS incidence peaked after 80 years in women and men aged 60-79 years.
Topics: Male; Humans; Female; Hemifacial Spasm; Incidence; Prevalence; Retrospective Studies; Finland
PubMed: 36804510
DOI: 10.1016/j.jns.2023.120587 -
Life (Basel, Switzerland) Oct 2023(1) Background: In cases of hemifacial spasm (HFS), there are various patterns related to the vascular compression of the facial nerve, including a very rare form that...
(1) Background: In cases of hemifacial spasm (HFS), there are various patterns related to the vascular compression of the facial nerve, including a very rare form that is seen when the offending vessel penetrates the facial nerve. However, there have been few reports in the literature regarding the associated surgical techniques and postoperative prognosis. (2) Methods: A retrospective review was conducted of 4755 patients who underwent microvascular decompression (MVD) surgery from April 1997 to June 2023. In total, 8 out of the 4755 patients (0.2%) exhibited a penetrating offending vessel; the medical and surgical records of these 8 patients were then analyzed. Surgery was then attempted to maximally decompress the penetrating offender. (3) Results: Seven out of the eight patients (87.5%) were spasm-free immediately after surgery, and one had only 10% residual spasm compared to their preoperative condition. That patient was also spasm-free one year later. Postoperative facial palsy occurred in one patient (12.5%) who was assessed as grade II in the House-Brackmann grading system. In another patient, the resection of a small facial nerve bundle did not result in facial palsy. There were no cases of hearing loss or other complications. (4) Conclusions: Decompressing the penetrating offender did not increase the incidence of facial palsy, and the prognosis for hemifacial spasms was good. Therefore, when a penetrating pattern was encountered during MVD surgery, decompression between the penetrating offender and the facial nerve may offer good results.
PubMed: 37895403
DOI: 10.3390/life13102021