Microvascular decompression in patients with hemifacial spasm

Abstract

PurposeTo study blood pressure alterations after microvascular decompression (MVD) surgery in patients with hemifacial spasm (HFS).MethodsA retrospective study was performed to review HFS patients who received MVD surgery between January 2014 and December 2016. Vessels that were considered to be responsible for HFS were determined by reviewing the brain magnetic resonance imaging, magnetic resonance angiography, and surgical video. Blood pressure measurements were performed 1 day before (preoperative) and 7 days after (postoperative) the MVD surgery. Pre‐ and postoperative blood pressure measurements were compared.ResultsA total of 374 patients were included in the study, with 118 (31.6%) male patients, age 53.8 ± 9.9 years old, and 141 (37.7%) patients with hypertension. Systolic blood pressure had statistically significant decrease in patients with (134.5 ± 8.2–132.6 ± 9.1 mmHg, p = .01) or without (125.6 ± 9.1–123.8 ± 10.0 mmHg, p = .01) hypertension. Diastolic blood pressure only had statistically significant decrease in patients with hypertension (83.0 ± 5.8–82.0 ± 6.5 mmHg, p = .04). Analyses in all the study patients and in the subgroup of patients with hypertension showed that more statistically significant blood pressure reductions were observed when left‐side vessel or vertebrobasilar artery was involved.ConclusionIn patients with HFS, MVD not only decreased blood pressure in patients with hypertension but also affected blood pressure in patients without hypertension. Blood pressure reductions were more prominent when left‐side vessel or vertebrobasilar artery was involved.

Child-onset Hemifacial Spasm-a case report

“…Secondary HFS was caused by compression of local lesions near the nerve [6,7]. The pathogenic mechanism of the primary HFS is not totally made clear, but NVC of the nerve, especially REZ is the most accepted [3,8]. AICA and PICA is the most common culprit vessels, followed by SCA PV and VBA [3,8,9].…”

“…HFS is a common cranial nerve disease, mainly manifests as muscle involuntary contractions restricted in the distribution of facial nerve, generally lower eyelid onset, and gradually aggravates to involve the ipsilateral face [1][2][3]. This disease usually occurs spontaneously and deteriorate as patients are stressful or fatigue [4], but also caused by mini stimulation.…”

“…For the compression results in local demyelination, and hyper excitability. Among the compressional arteries, anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) are the most common, and rarely superior cerebellar artery (SCA), petrosal vein (PV) and vertebrobasilar artery (VBA) [3,8,9]. Many researches indicated that HFS is mainly involved middle aged and elderly people [3,8], it is extremely rare in childhood and adolescence [10,11].…”

“…This disease usually occurs spontaneously and deteriorate as patients are stressful or fatigue [4], but also caused by mini stimulation. Generally speaking, HFS spasm involves only unilateral face [5], mainly the left side [3]. HFS could be divided into primary and secondary based on the potential etiology and primary HFS in majority of cases.…”

“…Secondary HFS is usually caused by facial nerve injury or compression of nearby primary lesions, such as tumor, in ammatory plaques [6,7]. Primary HFS is generally caused by neurovascular con ict (NVC), especially root exit zone (REZ) of this nerve [3,8]. For the compression results in local demyelination, and hyper excitability.…”