J Korean Neurosurg Soc.  2013 Jun;53(6):364-367. 10.3340/jkns.2013.53.6.364.

Delayed Unilateral Soft Palate Palsy without Vocal Cord Involvement after Microvascular Decompression for Hemifacial Spasm

• Park JH
• Jo KI
• Park K

• KMID: 2190825
• DOI: http://doi.org/10.3340/jkns.2013.53.6.364

Abstract

Microvascular decompression is a very effective and relatively safe surgical modality in the treatment of hemifacial spasm. But rare debilitating complications have been reported such as cranial nerve dysfunctions. We have experienced a very rare case of unilateral soft palate palsy without the involvement of vocal cord following microvascular decompression. A 33-year-old female presented to our out-patient clinic with a history of left hemifacial spasm for 5 years. On postoperative 5th day, patient started to exhibit hoarsness with swallowing difficulty. Symptoms persisted despite rehabilitation. Various laboratory work up with magnetic resonance image showed no abnormal lesions. Two years after surgery patient showed complete recovery of unitaleral soft palate palsy. Various etiologies of unilateral soft palate palsy are reviewed as the treatment and prognosis differs greatly on the cause. Although rare, it is important to keep in mind that such complication could occur after microvascular decompression.

Keyword

Microvascular decompression; Hemifacial spasm; Lower cranial nerve; Soft palate palsy; Vocal cord

MeSH Terms

Cranial Nerves
Deglutition
Female
Hemifacial Spasm
Humans
Magnetic Resonance Spectroscopy
Microvascular Decompression Surgery
Outpatients
Palate, Soft
Paralysis
Prognosis
Vocal Cords

Figure

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  Fig. 1 Preoperative MRI showing compression of the left facial nerve by anterior inferior cerebellar artery at the nerve root entry zone (offending artery is indicated by the arrow). No other structural abnormalities are noted. A: 3D T2 VISTA image. B: 3D TOF MR angiography image.

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  Fig. 2 Endoscopic evaluation of the larynx and vocal cord. A: Symmetric and mobile vocal cord. B: Uvula deviation to the right showing functional impairment of tensor and/or levator veli palatini muscle which is innervated by the vagus nerve.

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  Fig. 3 A: Postoperative cranial nerve MRI showing encephalomalacia in the left cerebellar hemisphere, which is a postoperative change without evidence of significant abnormality along the pathway of intracranial portion of the lower cranial nerves. B: Postoperative T2 weighted image showing successful decompression with teflon felt placed between the offending artery and facial nerve (arrow).

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  Fig. 4 Follow up endocopic evaluation showing symmetric and mobile vocal cord movement within normal limits (A), and complete and symmetric valo closure showing normalized vagus nerve function (B).

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