J Korean Neurosurg Soc.  2012 Aug;52(2):85-91. 10.3340/jkns.2012.52.2.85.

The Effect of Microvascular Decompression for Hemifacial Spasm Caused by Vertebrobasilar Dolichoectasia

• Kang JH
• Kang DW
• Chung SS
• Chang JW

• KMID: 2190544
• DOI: http://doi.org/10.3340/jkns.2012.52.2.85

Abstract

OBJECTIVE
Hemifacial spasm (HFS) caused by vertebrobasilar dolichoectasia (VBD) is very rare, and in theses cases, it is difficult to decompress the nerve from its vascular compression. The objective of this study was to investigate the outcome of microvascular decompression (MVD) for HFS caused by VBD.
METHODS
There were 10 patients of HFS caused by VBD at our hospital between September 1978 and September 2008. We evaluated magnetic resonance angiography (MRA) and time of flight magnetic resonance imaginge (TOF MRI) findings using the criteria for VBD. We compared the clinical outcomes of MVD for the 10 patients with VBD with the overall outcomes of the total 2058 MVDs performed for HFS.
RESULTS
The results of MVD for HFS caused by VBD were successful in 90.9% of cases. The postoperative complication rate in VBD was 45.5%. Offending vessels in patients with VBD were identified visually during surgery. Adverse effects after MVD were found in 4 patients. We found that the diameter of VBD was significantly greater in patients with complications than in those with no complications (p=0.028).
CONCLUSION
Our data shows that MVD may be a good treatment modality for HFS caused by VBD but care must be taken to avoid adverse effects from the procedure. It is important to detach the dolichoectatic artery from its surrounding structures sufficiently to allow it to be easily movable. In addition, attempts should be made to lessen the retraction of the cerebellum during release of the dolichoectatic artery.

Keyword

Microvascular decompression; Hemifacial spasm; Vertebrobasilar dolichoectasia

MeSH Terms

Arteries
Cerebellum
Hemifacial Spasm
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Microvascular Decompression Surgery
Postoperative Complications
Vertebrobasilar Insufficiency

Figure

• 

  Fig. 1 Preoperative MRI and photograph taken during surgery of a patient with right VA offender. The patient was 69-year-old man with a left side facial spasm for 5 years. Preoperative MRI shows that right side VA compressed left facial nerve at the REZ (red arrows). Photograph was taken before neurovascular decompression was performed. Surgical outcome was 'good' but permanent facial palsy developed. VA basilar artery, VII facial nerve. VA : vertebral artery, REZ : root exit zone.

• 

  Fig. 2 Preoperative MRI of a patient with AICA offender and BA over AICA. The patient was 48-year-old man with right side facial spasm for 2 years. Preoperative MRI shows that AICA compressed facial nerve and BA is over AICA offender (circle) at the REZ. During MVD, we made an effort to make BA movable freely. After surgery, HFS completely resolved but transient facial palsy occurred. AICA : anterior inferior cerebellar artery, REZ : root exit zone, MVD : microsurgical neurovascular decompression, BA : basilar artery.

• 

  Fig. 3 Preoperative and postoperative MRI of a patient with bilateral HFS. The patient was 50s woman with bilateral HFS. Left side facial spasm resulting from VA and PICA occurred one year before first MVD. Preoperative MRI shows that dolichoectatic VA and PICA compressing left facial nerve at the REZ (short arrow). After MVD, left HFS completely resolved but transient facial palsy and hearing impairment occurred. Right side HFS occurred 4 years after left MVD. We obtained postoperative MRI showing that only AICA compressed facial nerve (long arrow) and that complete decompression of left facial nerve was done (circle). After right MVD, right HFS completely disappeared without any complication. In the right HFS, VBD did not affect the offender. HFS : hemifacial spasm, VA : vertebral artery, PICA : posterior inferior cerebellar artery, REZ : root exit zone, MVD : microsurgical neurovascular decompression, VBD : vertebrobasilar dolichoectasia.

Reference

1. Arantes M, Garcia R, Pereira JR, Costa M. [Hemifacial spasms and vertebral dolichoectasias]. Rev Neurol. 2008; 47:468–470. PMID: 18985596.

2. Campbell E, Keedy C. Hemifacial spasm; a note on the etiology in two cases. J Neurosurg. 1947; 4:342–347. PMID: 20254516.

3. Carella A, Caruso G, Lamberti P. Hemifacial spasm due to elongation and ectasia of the distal segment of the vertebral artery. Report of two cases. Neuroradiology. 1973; 6:233–236. PMID: 4772449.

4. Chakravarty A. Hemifacial spasm, glossodynia, and dolichoectasia of the basilar artery. J Stroke Cerebrovasc Dis. 2012; 21:78–81. PMID: 20833080.

5. De Georgia M, Belden J, Pao L, Pessin M, Kwan E, Caplan L. Thrombus in vertebrobasilar dolichoectatic artery treated with intravenous urokinase. Cerebrovasc Dis. 1999; 9:28–33. PMID: 9873160.

6. de Oliveira Rde M, Cardeal JO, Lima JG. [Basilar ectasia and stroke : clinical aspects of 21 cases]. Arq Neuropsiquiatr. 1997; 55:558–562. PMID: 9629405.

7. Deeb ZL, Jannetta PJ, Rosenbaum AE, Kerber CW, Drayer BP. Tortuous vertebrobasilar arteries causing cranial nerve syndromes : screening by computed tomography. J Comput Assist Tomogr. 1979; 3:774–778. PMID: 229135.

8. Flemming KD, Josephs K, Wijdicks EF. Enlarging vertebrobasilar dolichoectasia with subarachnoid hemorrhage heralded by recurrent ischemia. Case illustration. J Neurosurg. 2000; 92:504. PMID: 10701548.

9. Giang DW, Perlin SJ, Monajati A, Kido DJ, Hollander J. Vertebrobasilar dolichoectasia : assessment using MR. Neuroradiology. 1988; 30:518–523. PMID: 3226539.

10. Han IB, Chang JH, Chang JW, Huh R, Chung SS. Unusual causes and presentations of hemifacial spasm. Neurosurgery. 2009; 65:130–137. discussion 137. PMID: 19574834.

11. Himi T, Kataura A, Tokuda S, Sumi Y, Kamiyama K, Shitamichi M. Downbeat nystagmus with compression of the medulla oblongata by the dolichoectatic vertebral arteries. Am J Otol. 1995; 16:377–381. PMID: 8588634.

12. Hongo K, Nakagawa H, Morota N, Isobe M. Vascular compression of the medulla oblongata by the vertebral artery : report of two cases. Neurosurgery. 1999; 45:907–910. PMID: 10515488.

13. Ishikawa M, Ohira T, Namiki J, Kobayashi M, Takase M, Kawase T, et al. Electrophysiological investigation of hemifacial spasm after microvascular decompression : F waves of the facial muscles, blink reflexes, and abnormal muscle responses. J Neurosurg. 1997; 86:654–661. PMID: 9120630.

14. Jannetta PJ, Abbasy M, Maroon JC, Ramos FM, Albin MS. Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg. 1977; 47:321–328. PMID: 894338.

15. Kim JP, Park BJ, Choi SK, Rhee BA, Lim YJ. Microvascular decompression for hemifacial spasm associated with vertebrobasilar artery. J Korean Neurosurg Soc. 2008; 44:131–135. PMID: 19096662.

16. Kim P, Ishijima B, Takahashi H, Shimizu H, Yokochi M. Hemiparesis caused by vertebral artery compression of the medulla oblongata. Case report. J Neurosurg. 1985; 62:425–429. PMID: 3973710.

17. Lin CF, Chen HH, Hernesniemi J, Lee CC, Liao CH, Chen SC, et al. An easy adjustable method of ectatic vertebrobasilar artery transposition for microvascular decompression. Clin Neurol Neurosurg. 2012; 114:951–956. PMID: 22390889.

18. Maruyama K, Tanaka M, Ikeda S, Tada T, Yanagisawa N. [A case report of quadriparesis due to compression of the medulla oblongata by the elongated left vertebral artery]. Rinsho Shinkeigaku. 1989; 29:108–111. PMID: 2743680.

19. McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK. Microvascular decompression of cranial nerves : lessons learned after 4400 operations. J Neurosurg. 1999; 90:1–8. PMID: 10413149.

20. Milandre L, Bonnefoi B, Pestre P, Pellissier JF, Grisoli F, Khalil R. [Vertebrobasilar arterial dolichoectasia. Complications and prognosis]. Rev Neurol (Paris). 1991; 147:714–722. PMID: 1775825.

21. Milandre L, Martini P, Perot S, Mercier C. Pure motor hemiparesis in a case of vertebrobasilar arterial ectasia. Neuroradiology. 1993; 35:196–198. PMID: 8459918.

22. Miyazaki M, Hashimoto T, Sakurama N, Yoshimoto T, Tayama M, Kuroda Y. Central sleep apnea and arterial compression of the medulla. Ann Neurol. 1991; 29:564–565. PMID: 1859186.

23. Moss MS, West RJ. Ectasia of the vertebral artery as a cause of isolated pyramidal tract signs : case report and a review of the literature. Br J Neurosurg. 1996; 10:497–499. PMID: 8922711.

24. Nuti D, Passero S, Di Girolamo S. Bilateral vestibular loss in vertebrobasilar dolichoectasia. J Vestib Res. 1996; 6:85–91. PMID: 8925119.

25. Papapetropoulos S, Argyriou AA, Guevara A, Sengun C, Mitsi G, Singer C. Hemifacial spasm and pontine compression caused by a giant vertebrobasilar dolichoectasia. Cerebrovasc Dis. 2009; 27:413–414. PMID: 19295203.

26. Rabb CH, Barnwell SL. Catastrophic subarachnoid hemorrhage resulting from ruptured vertebrobasilar dolichoectasia : case report. Neurosurgery. 1998; 42:379–382. PMID: 9482190.

27. Rahman EA, Trobe JD, Gebarski SS. Hemifacial spasm caused by vertebral artery dolichoectasia. Am J Ophthalmol. 2002; 133:854–856. PMID: 12036693.

28. Smoker WR, Corbett JJ, Gentry LR, Keyes WD, Price MJ, McKusker S. High-resolution computed tomography of the basilar artery : 2. Vertebrobasilar dolichoectasia : clinical-pathologic correlation and review. AJNR Am J Neuroradiol. 1986; 7:61–72. PMID: 3082145.

29. Smoker WR, Price MJ, Keyes WD, Corbett JJ, Gentry LR. High-resolution computed tomography of the basilar artery : 1. Normal size and position. AJNR Am J Neuroradiol. 1986; 7:55–60. PMID: 3082144.

30. Titlić M, Vrebalov-Cindro V, Lahman-Dorić M, Buca A, Jukić I, Tonkić A. Hemifacial spasm in vertebrobasilar dolichoectasia. Acta Neurol Belg. 2006; 106:23–25. PMID: 16776433.

31. Ubogu EE, Chase CM, Verrees MA, Metzger AK, Zaidat OO. Cervicomedullary junction compression caused by vertebral artery dolichoectasia and requiring surgical treatment. Case report. J Neurosurg. 2002; 96:140–143. PMID: 11794596.

32. Ubogu EE, Zaidat OO. Vertebrobasilar dolichoectasia diagnosed by magnetic resonance angiography and risk of stroke and death : a cohort study. J Neurol Neurosurg Psychiatry. 2004; 75:22–26. PMID: 14707300.

33. Vincentelli F, Caruso G, Rabehanta PB, Rey M. Surgical treatment of a rare congenital anomaly of the vertebral artery : case report and review of the literature. Neurosurgery. 1991; 28:416–420. PMID: 2011224.

34. Wolfe T, Ubogu EE, Fernandes-Filho JA, Zaidat OO. Predictors of clinical outcome and mortality in vertebrobasilar dolichoectasia diagnosed by magnetic resonance angiography. J Stroke Cerebrovasc Dis. 2008; 17:388–393. PMID: 18984433.

35. Yu YL, Moseley IF, Pullicino P, McDonald WI. The clinical picture of ectasia of the intracerebral arteries. J Neurol Neurosurg Psychiatry. 1982; 45:29–36. PMID: 7062068.