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Unusual causes and presentations of hemifacial spasm

 In-Bo Han  ;  Jong Hee Chang  ;  Jin Woo Chang  ;  Ryoong Huh  ;  Sang Sup Chung 
 NEUROSURGERY, Vol.65(1) : 130-137, 2009 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Decompression, Surgical/adverse effects ; Decompression, Surgical/methods ; Facial Nerve ; Female ; Hemifacial Spasm/etiology* ; Hemifacial Spasm/surgery ; Humans ; Male ; Middle Aged ; Nerve Compression Syndromes/complications* ; Nerve Compression Syndromes/pathology ; Neurosurgical Procedures/adverse effects ; Neurosurgical Procedures/methods ; Retrospective Studies ; Vascular Diseases/complications* ; Vascular Diseases/surgery ; Young Adult
Bilateral ; Dolichoectasia ; Facial nerve ; Hemifacial spasm ; Neurovascular compression ; Tic convulsif
OBJECTIVE: To evaluate unusual possible causes and clinical presentations of hemifacial spasm (HFS). METHODS: The authors reviewed 1642 cases of HFS. Assessments were based on clinical features, 3-dimensional time-of-flight magnetic resonance angiography, and surgical findings. Causes other than neurovascular compression at the root exit zone of the facial nerve were investigated and unusual clinical presentations were noted. RESULTS: Nine (0.5%) patients had a secondary causative structural lesion, 7 patients had a tumor, and the remaining 2 had a vascular malformation. Direct compression by dolichoectatic vertebrobasilar artery was noted in 12 (0.7%) patients. In 7 (0.4%) patients, only the distal portion of the facial nerve was compressed, and five (0.3%) had only venous compression. Bilateral HFS and tic convulsif were encountered in 7 (0.4%) and 6 (0.37%) patients, respectively. Fifty-six (3.4%) patients were younger than 30 years old at the time of microvascular decompression. CONCLUSION: HFS can result from tumor, vascular malformation, and dolichoectatic artery. Therefore, appropriate preoperative radiological investigations are crucial to achieve a correct diagnosis. The authors emphasize that distal compression or only venous compression can be responsible for persistent or recurrent symptoms postoperatively. In cases of bilateral HFS, a definite differential diagnosis is necessary for appropriate therapy. MVD is recommended as the treatment of choice in patients younger than 30 years old or patients with painful tic convulsif
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Chang, Jong Hee(장종희) ORCID logo https://orcid.org/0000-0003-1509-9800
Chang, Jin Woo(장진우) ORCID logo https://orcid.org/0000-0002-2717-0101
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