J Korean Neurosurg Soc.  2015 Mar;57(3):221-224. 10.3340/jkns.2015.57.3.221.

A Case of Hemifacial Spasm Caused by an Artery Passing Through the Facial Nerve

• Oh CH
• Shim YS
• Park H
• Kim EY

• KMID: 2191227
• DOI: http://doi.org/10.3340/jkns.2015.57.3.221

Abstract

Hemifacial spasm (HFS) is a clinical syndrome characterized by unilateral facial nerve dysfunction. The usual cause involves vascular compression of the seventh cranial nerve, but compression by an artery passing through the facial nerve is very unusual. A 20-year-old man presented with left facial spasm that had persisted for 4 years. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery (AICA) was revealed on magnetic resonance angiography. During microvascular decompression surgery, penetration of the distal portion of the facial nerve root exit zone by the AICA was observed. At the penetrating site, the artery was found to have compressed the facial nerve and to be immobilized. The penetrated seventh cranial nerve was longitudinally split about 2 mm. The compressing artery was moved away from the penetrating site and the decompression was secured by inserting Teflon at the operative site. Although the facial spasm disappeared in the immediate postoperative period, the patient continued to show moderate facial weakness. At postoperative 12 months, the facial weakness had improved to a mild degree. Prior to performing microvascular decompression of HFS, surgeons should be aware of a possibility for rare complex anatomy, such as compression by an artery passing through the facial nerve, which cannot be observed by modern imaging techniques.

Keyword

Hemifacial spasm; Penetrating artery; Facial nerve; Facial weakness

MeSH Terms

Arteries*
Decompression
Facial Nerve*
Hemifacial Spasm*
Humans
Magnetic Resonance Angiography
Microvascular Decompression Surgery
Polytetrafluoroethylene
Postoperative Period
Spasm
Young Adult
Polytetrafluoroethylene

Figure

• 

  Fig. 1 Preoperative magnetic resonance angiography. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery is observed.

• 

  Fig. 2 Intraoperative findings. Penetration of the distal portion of the facial nerve root exit zone by the anterior inferior cerebellar artery is revealed (arrow). After longitudinally splitting the penetrated nerve, the compressing artery was moved away from the penetrating site and the decompression was secured by insertion of Teflon.

• 

  Fig. 3 Postoperative photographs. The patient showed moderate facial weakness although the facial spasm disappeared in the immediate postoperative period (A and B). After 4 months of follow-up (C and D), the facial weakness had improved to a mild degree, from House and Brackmann grade 4 to 2.

Reference

1. Adler CH, Zimmerman RA, Savino PJ, Bernardi B, Bosley TM, Sergott RC. Hemifacial spasm : evaluation by magnetic resonance imaging and magnetic resonance tomographic angiography. Ann Neurol. 1992; 32:502–506. PMID: 1456734.

2. Altinörs N, Kars Z, Cepoğlu C. Rare causes of hemifacial spasm. Report of two cases. Clin Neurol Neurosurg. 1991; 93:155–158. PMID: 1652399.

3. Auger RG, Piepgras DG. Hemifacial spasm associated with epidermoid tumors of the cerebellopontine angle. Neurology. 1989; 39:577–580. PMID: 2927684.

4. Barraquer-Bordas , Zamora S, Abello-Vila P. [Hemifacial spasm and bilateral central deafness in the clinical picture of possible syringobulbia]. Rev Esp Otoneurooftalmol Neurocir. 1955; 14:17–22. PMID: 14395752.

5. Bhayani R, Goel A. Occipital falcine meningioma presenting with ipsilateral hemifacial spasm : a case report. Br J Neurosurg. 1996; 10:603–605. PMID: 9115659.

6. Bills DC, Hanieh A. Hemifacial spasm in an infant due to fourth ventricular ganglioglioma. Case report. J Neurosurg. 1991; 75:134–137. PMID: 2045898.

7. Coakham HB. The microvascular treatment of trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia. In : Robertson JT, Coakham HB, Robertson JH, editors. Cranial base surgery. New York: Churchill Livingston;2000. p. 543–564.

8. Destee A, Bouchez B, Pellegrin P, Warot P. Hemifacial spasm associated with a mixed benign parotid tumour. J Neurol Neurosurg Psychiatry. 1985; 48:189–190. PMID: 2984333.

9. Digre K, Corbett JJ. Hemifacial spasm : differential diagnosis, mechanism, and treatment. Adv Neurol. 1988; 49:151–176. PMID: 3278539.

10. Ehni G, Woltman HW. Hemifacial spasm : review of one hundred and six cases. Arch Neurol Psychiatry. 1945; 53:205–211.

11. Gálvez-Jiménez N, Hanson MR, Desai M. Unusual causes of hemifacial spasm. Semin Neurol. 2001; 21:75–83. PMID: 11346028.

12. Gandon J, Trotoux J, Peynègre R, André J, Brasnu D. [Study of a series of 158 parotidectomies and histological problems in mixed tumors of salivary glands (author's transl)]. Ann Otolaryngol Chir Cervicofac. 1979; 96:261–280. PMID: 225977.

13. Genís D, Ricart W, Fernández-Real JM, Dávalos A, Molins A, Ferrándiz M. Hemifacial spasm and hypothyroidism. Lancet. 1993; 342:1112. PMID: 8105329.

14. Girard N, Poncet M, Caces F, Tallon Y, Chays A, Martin-Bouyer P, et al. Three-dimensional MRI of hemifacial spasm with surgical correlation. Neuroradiology. 1997; 39:46–51. PMID: 9121649.

15. 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.

16. Ing EB, Savino PJ, Bosley TM, Sergott RC, Kelepouris N. Hemifacial spasm and osteitis deformans. Am J Ophthalmol. 1995; 119:376–377. PMID: 7872405.

17. Inoue T, Maeyama R, Ogawa H. Hemifacial spasm resulting from cerebellopontine angle lipoma : case report. Neurosurgery. 1995; 36:846–850. PMID: 7596519.

18. Janetta PJ. Cranial Rhizopathies : Neurological Surgery. ed 3. Philadelphia: W.B. Saunders;1990. p. 4169–4182.

19. Jannetta PJ. Microsurgical exploration and decompression of the facial nerve in hemifacial spasm. Cuff Topics Surg Res. 1970; 2:217–220.

20. 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.

21. Kerber CW, Margolis MT, Newton TH. Tortuous vertebrobasilar system : a cause of cranial nerve signs. Neuroradiology. 1972; 4:74–77. PMID: 4343431.

22. Kier EL. Development of cerebral vessels. In : Newton TH, Potts DG, editors. Radiology of the skull and brain. St. Louis: Mosby;1974. p. 1089–1141.

23. Kiley MA, Voyvodic F, Burns RJ. An unusual cause of hemifacial spasm. J Clin Neurosci. 1999; 6:349–351. PMID: 10844764.

24. Kim Y, Tanaka A, Kimura M, Yoshinaga S, Tomonaga M. Arteriovenous malformation in the cerebellopontine angle presenting as hemifacial spasm--case report. Neurol Med Chir (Tokyo). 1991; 31:109–112. PMID: 1715038.

25. Linazasoro G, Martí Massó JF. Paget's disease and hemifacial spasm. Neurology. 1992; 42:1643–1644. PMID: 1641175.

26. Loeser JD, Chen J. Hemifacial spasm : treatment by microsurgical facial nerve decompression. Neurosurgery. 1983; 13:141–146. PMID: 6888693.

27. Maroon JC. Hemifacial spasm. A vascular cause. Arch Neurol. 1978; 35:481–483. PMID: 666603.

28. Maroun FB, Jacob JC, Weir BK, Mangan MA. Hemifacial spasm and craniovertebral anomaly. Can J Neurol Sci. 1990; 17:424–426. PMID: 2276101.

29. Martinelli P, Giuliani S, Ippoliti M. Hemifacial spasm due to peripheral injury of facial nerve : a nuclear syndrome? Mov Disord. 1992; 7:181–184. PMID: 1584239.

30. Matsuura N, Kondo A. Trigeminal neuralgia and hemifacial spasm as false localizing signs in patients with a contralateral mass of the posterior cranial fossa. Report of three cases. J Neurosurg. 1996; 84:1067–1071. PMID: 8847575.

31. Nishi T, Matsukado Y, Nagahiro S, Fukushima M, Koga K. Hemifacial spasm due to contralateral acoustic neuroma : case report. Neurology. 1987; 37:339–342. PMID: 3808320.

32. Nussbaum M. Hemifacial spasm associated with benign parotid tumor. Ann Otol Rhinol Laryngol. 1977; 86(1 Pt 1):73–74. PMID: 189664.

33. Oliveira LD, Cardoso F, Vargas AP. Hemifacial spasm and arterial hypertension. Mov Disord. 1999; 14:832–835. PMID: 10495046.

34. Osborn AG. Diagnostic cerebral angiography. ed 2. Philadelphia: Lippincott Williams & Wilkins Publishers;1999.

35. Rapanà A, Guida F, Conti C, Rizzo G, Trincia G. Ependymoma of the fourth ventricle presenting with hemifacial spasm Report of a case. Rev Neurol (Paris). 1999; 155:309–311. PMID: 10367329.

36. Sataloff RT. Embryology and anomalies of the facial nerve and their surgical implications. New York: Raven Press;1991.

37. Selky AK, Purvin VA. Hemifacial spasm. An unusual manifestation of idiopathic intracranial hypertension. J Neuroophthalmol. 1994; 14:196–198. PMID: 7881522.

38. Singh AK, Jain VK, Chhabra DK, Hongo K, Kobayashi S. Hemifacial spasm and cerebellopontine angle epidermoid : case report and review. Neurol Res. 1994; 16:321–323. PMID: 7984265.

39. Tan EK, Chan LL, Lim SH, Lim WE, Khoo JB, Tan KP. Role of magnetic resonance imaging and magnetic resonance angiography in patients with hemifacial spasm. Ann Acad Med Singapore. 1999; 28:169–173. PMID: 10497660.

40. Tan EK, Jankovic J. Psychogenic hemifacial spasm. J Neuropsychiatry Clin Neurosci. 2001; 13:380–384. PMID: 11514645.

41. Tan NC, Chan LL, Tan EK. Hemifacial spasm and involuntary facial movements. QJM. 2002; 95:493–500. PMID: 12145388.

42. van de Biezenbos JB, Horstink MW, van de Vlasakker CJ, van Engelen BG, van Eikema Hommes OR, Barkhof F. A case of bilateral alternating hemifacial spasms. Mov Disord. 1992; 7:68–70. PMID: 1557068.

43. Vermersch P, Petit H, Marion MH, Montagne B. Hemifacial spasm due to pontine infarction. J Neurol Neurosurg Psychiatry. 1991; 54:1018. PMID: 1800652.

44. Wang A, Jankovic J. Hemifacial spasm : clinical findings and treatment. Muscle Nerve. 1998; 21:1740–1747. PMID: 9843077.

45. Westra I, Drummond GT. Occult pontine glioma in a patient with hemifacial spasm. Can J Ophthalmol. 1991; 26:148–151. PMID: 2054726.