Ehab El Refaee1,2, Sascha Marx3, Christian Rosenstengel3, Joerg Baldauf3, Henry W S Schroeder3. 1. Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany. e.elrefaee@googlemail.com. 2. Department of Neurosurgery, Cairo University, Cairo, Egypt. e.elrefaee@googlemail.com. 3. Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany.
Abstract
BACKGROUND: Hemifacial spasm is usually caused by arterial compression at the root exit zone of the facial nerve. However, other etiologies have been reported. The aim of this study was to analyze the frequency of other causes of hemifacial spasm. METHODS: Our prospectively maintained hemifacial spasm database containing all patients who underwent microvascular decompression (MVD) for hemifacial spasm from 2002 to 2018 was reviewed. All offending structures were identified and recorded by the surgeon at the time of surgery. Additionally, the operative videos were analyzed retrospectively. RESULTS: MVD was performed in 353 patients. Arterial compression was the main cause of hemifacial spasm in 341 (96.9%) patients. Combined venous-arterial compression was seen in 7 (2.0%) patients. In one patient, the compression was from a large vein. In two patients, no compression was found. One patient who suffered from Bell's palsy many years previously had severe synkinesis and the other had facial tics. In two patients, the spasm was caused due to strangulation of the facial nerve by arachnoid bands. Long-term follow-up of more than 18 months was available in 249 patients with total resolution or near total resolution of spasms in 89.96% of patients. CONCLUSIONS: In most patients with hemifacial spasm, arterial vessels are involved in compressing the facial nerve. Purely venous compression is rarely encountered. We report for the very first time arachnoid bands strangulating the nerve as a cause for hemifacial spasm without involvement of any vessel.
BACKGROUND:Hemifacial spasm is usually caused by arterial compression at the root exit zone of the facial nerve. However, other etiologies have been reported. The aim of this study was to analyze the frequency of other causes of hemifacial spasm. METHODS: Our prospectively maintained hemifacial spasm database containing all patients who underwent microvascular decompression (MVD) for hemifacial spasm from 2002 to 2018 was reviewed. All offending structures were identified and recorded by the surgeon at the time of surgery. Additionally, the operative videos were analyzed retrospectively. RESULTS: MVD was performed in 353 patients. Arterial compression was the main cause of hemifacial spasm in 341 (96.9%) patients. Combined venous-arterial compression was seen in 7 (2.0%) patients. In one patient, the compression was from a large vein. In two patients, no compression was found. One patient who suffered from Bell's palsy many years previously had severe synkinesis and the other had facial tics. In two patients, the spasm was caused due to strangulation of the facial nerve by arachnoid bands. Long-term follow-up of more than 18 months was available in 249 patients with total resolution or near total resolution of spasms in 89.96% of patients. CONCLUSIONS: In most patients with hemifacial spasm, arterial vessels are involved in compressing the facial nerve. Purely venous compression is rarely encountered. We report for the very first time arachnoid bands strangulating the nerve as a cause for hemifacial spasm without involvement of any vessel.