RESUMO
Hemifacial spasm (HS) is a movement disorder characterized by paroxysmal and irregular contractions of the muscles innervated by the facial nerve. Chiari malformation type I (CM I) is a congenital disease characterized by caudal migration of the cerebellar tonsils, and surgical decompression of foramen magnum structures has been used for treatment. The association of HS with CM I is rare, and its pathophysiology and therapeutics are speculative. There are only a few cases reported in the literature concerning this association. The decompression of the posterior fossa for the treatment of CM I has been reported to relieve the symptoms of HS, suggesting a relation between these diseases. However, the possible complications of posterior fossa surgery cannot be underrated. We report the case of a 66-year-old patient, in ambulatory follow-up due to right HS, no longer responding to botulinum toxin treatment. Magnetic resonance imaging (MRI) of the skull revealed compression of the facial nerve and CM I. The patient underwent surgery for HS by neurovascular microdecompression of the facial nerve via right lateral suboccipital craniectomy, but presented significant clinical worsening in the postoperative period even though the cerebellum edema related to surgical manipulation was mild. Due to the clinical worsening, the patient underwent a median suboccipital craniectomy with decompression of the foramenmagnum structures. After this second surgery, the patient had progressive improvement and was discharged from the hospital for ambulatory care.
Assuntos
Humanos , Feminino , Idoso , Malformação de Arnold-Chiari/cirurgia , Malformação de Arnold-Chiari/complicações , Espasmo Hemifacial/cirurgia , Espasmo Hemifacial/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Espasmo Hemifacial/diagnóstico por imagem , Cirurgia de Descompressão Microvascular/métodosAssuntos
Espasmo Hemifacial/diagnóstico por imagem , Neuralgia do Trigêmeo/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Idoso , Espasmo Hemifacial/etiologia , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Neuralgia do Trigêmeo/etiologia , Insuficiência Vertebrobasilar/complicaçõesAssuntos
Espasmo Hemifacial/diagnóstico por imagem , Síndromes de Compressão Nervosa/diagnóstico , Adulto , Anticonvulsivantes/uso terapêutico , Colômbia/etnologia , Dibenzazepinas/uso terapêutico , Feminino , Gabapentina/uso terapêutico , Espasmo Hemifacial/tratamento farmacológico , Humanos , Contração Muscular , Espanha , Vertigem/etiologiaRESUMO
Objective In cases of hemifacial spasm caused by a tortuous vertebrobasilar artery (TVBA), the traditional treatment technique involves Teflon (polytetrafluoroethylene), which can be ineffective and fraught with recurrence and neurological complications. In such cases, there are various techniques of arteriopexy using adhesive compositions, 'suspending loops' made of synthetic materials, dural or fascial flaps, surgical sutures passed around or through the vascular adventitia, as well as fenestrated aneurysmal clips. In the present paper, we describe a new technique of slinging the vertebral artery (VA) to the petrous dura for microvascular decompression (MVD) in a patient with hemifacial spasm caused by a TVBA. Method A 50-year-old taxi driver presented with a left-sided severe hemifacial spasm. A magnetic resonance imaging (MRI) scan of the brain showed a large tortuous left-sided vertebral artery impinging and compressing the exit/entry zone of the 7th and 8th nerve complex. After a craniotomy, a TVBAwas found impinging and compressing the entry zone of the 7th and 8th nerve complex. Arachnoid bands attaching the artery to the nerve complex and the pons were released by sharp microdissection. Through the upper part of the incision, a 2.5 1 cmtemporal fascia free flap was harvested. After the fixation of the free flap, a 60 prolene suture was passed through its length several times using the traditional Bengali sewing and stitching techniques to make embroidered quilts called Nakshi katha. The'prolenated' fascia was passed around the compressing portion of the VA. Both ends of the fascia were brought together and stitched to the posterior petrous dura to keep the TVBA away from the 7th and 8th nerves and the pons. Result The patient had no hemifacial spasm immediately after the recovery from the anesthesia. A postoperative MRI of the brain showed that the VA was away from the entry zone of the 7th and 8th nerves.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Artéria Basilar/patologia , Espasmo Hemifacial/cirurgia , Espasmo Hemifacial/complicações , Espasmo Hemifacial/etiologia , Espasmo Hemifacial/diagnóstico por imagem , Craniotomia/métodos , Acidente Vascular Cerebral/complicações , Cirurgia de Descompressão Microvascular/métodosRESUMO
Objetivo: La compresión de una estructura nerviosa por un vaso aberrante puede ser asintomática o producir importante sintomatología; en éste caso las imágenes suministran una relevante información clínica y prequirúrgica. Material y métodos: Se estudiaron entre enero de 1998 y marzo de 2001, 27 pacientes: 8 con neuralgia del trigémino, 7 con hemiespasmo del facial, 4 con vértigo y tinnitus pulsátil, 2 con hemiespasmo del facial, 4 con vértigo y tinnitus pulsátil, 2 con hemianopsias, 1 con neuralgia de la fosa amigdalina, 1 con voz bitonal, 1 con hemiatrofia lingual derecha con fasciculaciones, 2 con hipertensión esencial y 1 con cefalea. Todos ellos presentaron evaluación neurológica por 2 especialistas y los resultados fueron interpretados por 2 neurorradiólogos. Resultados: Las imágenes por TC y RM con secuencias especiales permitieron evidenciar las compresiones de los segmentos de entrada de las raíces de los pares craneales V, VII, VIII, IX, X, XII, del quiasma óptico y de la cara anterolateral izquierda del bulbo raquídeo en estrecha relación con el centro vasopresor. También se visualizó un vaso anómalo en el Acueducto de Silvio, impidiendo el flujo normal del LCR. Del total de los pacientes estudiados, el 37 por ciento tuvo confirmación quirúrgica. Conclusiones: La TC y especialmente la RM con secuencias para visualización de vasos demostraron ser métodos muy sensibles y específicos en la detección de la lesión de una estructura nerviosa intracraneal, producto de la compresión por un vaso (AU)