Hemifacial spasm caused by the brainstem developmental venous anomaly: A case report and review of the literature

Abstract

Background: Hemifacial spasm (HFS) is usually caused by vascular compression of the root exit zone (REZ) of the facial nerve. Dual compression of the REZ by veins and arteries is also associated with HFS, but venous origin alone is rarely reported. We present a rare case of HFS caused by the brainstem developmental venous anomaly (DVA) treated with microvascular decompression (MVD). Case Description: A 30-year-old women presented with the left-sided HFS since the age of 18 years. The brainstem DVA was diagnosed by magnetic resonance imaging (MRI) and followed by two attempts of MVD at some other clinics without any improvement. At our hospital, MVD was performed through a left retromastoid craniotomy. Intraoperatively, after detaching the strong adhesions between the cerebellar hemisphere, petrosal dura and lower cranial nerves, and removing the Teflon sponge inserted during the previous operations, the compressing large vein was found, separated from facial nerve REZ and MVD was completed. The postoperative computed tomography angiography and MRI showed the thrombosis of the main trunk of DVA and decompression of the facial nerve REZ. Complete cessation of HFS with hearing preservation was observed with only slight weakness of mimic muscles which disappeared within 3 months after surgery. Conclusion: HFS associated with brainstem DVA is a very rare condition. MVD of the facial nerve REZ with transposition of the large draining vein should be considered as an effective treatment option.

Cerebral venous thrombosis: an unexpected Brissaud-Sicard syndrome mimicker

“…Offending vessels in descending frequency are the anterior inferior cerebellar artery, posterior inferior cerebellar artery, and vestibular artery. Dual compression of FNREZ by arteries and veins is mentioned; however, HFS caused solely by a venous offender is extremely rare, as only few cases associated with brainstem developmental venous anomaly [ 3 ] and a single case of HFS related to straight sinus occlusion in a 10-month infant [ 4 ] are mentioned. Congested and dilatated brainstem veins lying in close proximity to the FNREZ could be the irritants.…”

Microvascular decompression for developmental venous anomaly causing hemifacial spasm: illustrative case

“…The patient was spasm-free at 1 week, but no long-term follow-up was provided. Finally, Grigoryan et al 14 presented a case of left-sided HFS secondary to a left cerebellar DVA with two previous MVDs. The patient had a third MVD with evidence of DVA thrombosis on postoperative MRI and was spasm-free immediately and at the 3-month follow-up.…”

“…It is difficult to assess the outcomes of MVD for DVA-associated HFS with the limited number of cases in the literature. [12][13][14] Higher complication rates have been noted in MVD of veins for HFS. 6 Therefore, caution should be taken when considering the manipulation of brainstem veins.…”

“…One case was a DVA in the internal auditory canal, and two cases were cerebellar DVAs. [12][13][14] We present a unique case of HFS caused by facial nerve compression by a pontine DVA treated with MVD.…”

Subcutaneous injection of hyaluronic acid leading to emboliom and recanalization process monitored in real time by three-dimensional photoacoustic imaging

“…In current clinical practice, the detection of HA injection-related embolism is mainly done by observing whether the patient develops abnormal symptoms after the injection, such as local pain, swelling and other signs, and by performing blood tests and coagulation function tests [ [21] , [22] , [23] ]. There are also effective tests such as ultrasound, computer tomography and magnetic resonance imaging, which can help doctors monitor the blood flow and diagnose whether a clot has formed [ [24] , [25] , [26] ]. However, these methods may not be intuitive enough or require a large investment of medical resources, or may be invasive and pose hidden risks to patients.…”