Hemifacial Spasm Associated with Compression of the Facial Colliculus by a Choroid Plexus Papilloma of the Fourth Ventricle

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.

Choroid plexus papilloma at the root entry zone causing hemifacial spasm

“…HFS caused by CPP is rare, with only one reported case found in the literature, 3 and in that case, the tumor was clearly visible on MRI. In our case, however, the tumor remained undetected on the MRI and would have been missed if the REZ had not been meticulously scrutinized.…”

“…2 The incidence of HFS in adults related to tumors is approximately 0.3%-2.5%. 3 CPP is a benign neoplasm that accounts for approximately 0.5% of all adult brain tumors. Unlike other adult brain tumors, CPP predominantly occurs in the posterior fossa and rarely causes symptoms.…”

Lateral Spread Response: Unveiling the Smoking Gun for Cured Hemifacial Spasm

“…However, within the context of tumors originating from the facial nerve, such as facial nerve schwannomas, reports of facial spasm presentation are conspicuously absent [29][30][31]. This discrepancy may be attributed to the propensity of facial nerve If LSR disappears before decompression or persists after decompression, careful exploration is warranted.…”

“…However, within the context of tumors originating from the facial nerve, such as facial nerve schwannomas, reports of facial spasm presentation are conspicuously absent [29][30][31]. This discrepancy may be attributed to the propensity of facial nerve schwannomas to originate, predominantly, from the peripheral aspect of the facial nerve rather than from its Life 2023, 13, 1825 9 of 12 intracranial segment.…”

Rare Brain Tumors with Infrequent Clinical Manifestations: Illustrative Cases

“…Compression of the facial colliculus due to the presence of a tumor is an extremely rare cause, representing less than 0.6% of HFS cases [20]. What makes this case even more exceptional is that the tumor that was conditioning the compression of the facial colliculus was a choroid plexus papilloma (CPP), an uncommon benign intraventricular neuroepithelial tumor [21,22].…”