Utility of Intraoperative Electromyography in Microvascular Decompression for Hemifacial Spasm: a Meta-Analysis

Total Page:16

File Type:pdf, Size:1020Kb

Utility of Intraoperative Electromyography in Microvascular Decompression for Hemifacial Spasm: a Meta-Analysis Neurosurg Focus 27 (4):E10, 2009 Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis RAYMOND F. SEKULA JR., M.D., SAN J AY BHATIA , M.D., AND R EW M. FR EDE R ICK S ON , B.S., PETE R J. JANNETTA , M.D., MATTHEW R. QUIGLEY , M.D., GEO R GE A. SMALL , M.D., AND RYAN BR EI S INGE R , B.S. Center for Cranial Nerve Disorders, Department of Neurosurgery, Allegheny General Hospital, Allegheny Neuroscience Institute/Drexel University College of Medicine, Pittsburgh, Pennsylvania Object. In this paper, the authors’ goal was to determine the utility of monitoring the abnormal muscle response (AMR) or “lateral spread” during microvascular decompression surgery for hemifacial spasm. Methods. The authors’ experience with AMR as well as the data available in the English-language literature regarding resolution or persistence of AMR and the resolution or persistence of hemifacial spasm at follow-up was pooled and subjected to a meta-analysis. Results. The pooled OR revealed by the meta-analysis was 4.2 (95% CI 2.7–6.7). The chance of a cure if the AMR was abolished during surgery was 4.2 times greater than if the lateral spread persisted. Conclusions. The AMR should be monitored routinely in the operating room, and surgical decision-making in the operating room should be augmented by the AMR. (DOI: 10.3171/2009.8.FOCUS09142) KEY WO R D S • hemifacial spasm • intraoperative electromyography • lateral spread • abnormal motor response EMIFACIAL spasm, a syndrome of unilateral facial intraoperative EMG, it is unlikely that a large prospec- nerve hyperactive dysfunction, is a severe and tive, randomized multicenter trial will be undertaken. In disabling condition that causes impairments in the addition, because of the high cure rate of HFS a large Hquality of life of patients.4 Typical and atypical variations number of patients will be required to uncover a differ- of the disorder exist. In typical HFS, the spasms begin in- ence in outcome. sidiously in the orbicularis oculi muscle and spread over In this report, we will review the salient features time to muscles of the face with variable involvement of of EMG in HFS and our own results with intraopera- the frontalis and platysma muscles. Conversely, in atypi- tive EMG. We also performed a meta-analysis of com- cal HFS, spasms begin insidiously in the muscles of the bined data regarding the utility of intraoperative EMG lower face and spread to the orbicularis oculi muscle over for MVD in HFS. time. Typical HFS occurs much more frequently than atypical HFS.8 Intraoperative EMG has been used increasingly in Methods the surgical management of HFS.17 While several retro- This retrospective review of existing study materials spective and prospective studies have strongly supported was performed under a protocol approved by our institu- its use,6,21,27,31 several other studies have failed to show tional review board and in accordance with patient priva- that intraoperative EMG improves outcome (that is, a cy rights protection as enforced by the Health Insurance cure of HFS).1,3,9,11,28 To date, there are no reported ran- Portability and Accountability Act. domized controlled trials of intraoperative EMG that were designed or powered to study cure of HFS as the Preoperative Demographics primary end point. Because the majority of surgeons per- Between January 1, 2007, and May 31, 2009, we pro- forming MVD for HFS believe strongly about the use of spectively collected information on all patients with HFS who presented to our center. The diagnosis of HFS was Abbreviations used in this paper: AMR = abnormal muscle based on the clinical history and physical examination response; EMG = electromyography; HFS = hemifacial spasm; and then confirmed with EMG. A Gd-enhanced MR im- MVD = microvascular decompression. aging examination of the brain confirmed the absence of Neurosurg Focus / Volume 27 / October 2009 1 Unauthenticated | Downloaded 09/23/21 01:19 PM UTC R. F. Sekula Jr. et al. structural lesions including tumors, AVM, Chiari mal- ally, the AMR disappears as CSF is drained or retractors formation Type I, and other confounding diagnoses (for are placed, ostensibly causing a relaxation of vascular example, multiple sclerosis) in each patient. All patients compression of the facial nerve. An attempt is made to underwent preoperative EMG confirming the AMR. restore the AMR by increasing the current intensity (up No patient who met these criteria was denied operation. to 15 mA), stimulation frequency (5.1 Hz), and finally Eighty-six patients underwent MVD by the senior au- by increasing pulse widths in increments of 50 µsec. A thors (R.F.S. and P.J.J.). Thirteen of these patients were Cadwell Cascade (Cadwell Laboratories, Inc.) machine is excluded because they had undergone a previous MVD used at our institution. for HFS at another institution. Additionally, intraopera- During decompression of suspected arteries and tive AMR data were unavailable in 4 patients because the veins from the facial nerve, the intensity of the stimula- AMR was lost after the operation was begun but before tion is increased to make sure that the AMR has resolved. the facial nerve had been exposed. Thus, data for both the A further attempt is made to “drive” or stimulate the intraoperative resolution of the AMR and the postopera- AMR by increasing the current to 20 mA or frequency tive outcome were available in 69 patients and were used to 30 Hz. If the AMR cannot be driven, we consider the in this analysis. In the operating room, AMR was noted AMR to have completely resolved. as present (even if reduced by as much as 95%) or absent In addition to AMR monitoring, all patients under- (elimination of AMR). going MVD surgery are monitored for changes in the Following MVD, data were collected at routine post- brainstem auditory evoked potentials. Occasionally direct operative office visits and by formal telephone interviews stimulation of cranial nerve VII is used. of all patients in June 2009, which were conducted by a disinterested observer (A.M.F.). Each patient was evalu- Operative Procedure ated in our clinic on postoperative Day 5, and all patients Microvascular decompression is performed under were queried by telephone at the last follow-up. The me- general anesthesia with the patient in the contralateral dian follow-up was 10.7 months (range 1–28.6 months). decubitus position, utilizing auditory brainstem evoked Patients were queried regarding status of spasms immedi- 15 ately postoperatively and since MVD. The cases in which potentials in a previously described manner. A retro- patients reported that their facial spasms were eliminated mastoid incision is made behind the hairline, and a small or were reduced by ≥ 90% (for example, occasional “flut- craniectomy below the asterion is performed. The edge tering about eye”) were considered cured. of the sigmoid sinuses is identified, and the dura mater is opened. After appropriate brain relaxation is achieved Intraoperative EMG with CSF drainage, the cerebellum is gently elevated, and the root entry zone of the facial nerve is exposed and The AMR can be elicited in every patient with HFS. examined for vascular contact. In concert with our neu- The term “lateral spread” is often used interchangeably romonitoring team, arteries are decompressed from the with the term abnormal motor response. The term, how- facial nerve using shredded Teflon pledgets while some ever, should be reserved for describing the AMR in re- veins are coagulated using bipolar cautery or are pur- lationship to the theory of ephaptic transmission as the posely avulsed. term “lateral spread” neglects the theory of motor nucleus hyperexcitability. To monitor the AMR intraoperatively, Statistical Analysis we use a technique similar to that originally described by Nielsen.25 Depolarizing muscle relaxants are not used. Statistical analysis was performed with MedCalc Bipolar subdermal needle electrodes are placed 0.5–1 cm 9.001 for a personal computer. Specific tests used in each apart in the orbicularis oculi and mentalis muscles. The instance are documented below. orbicularis oculi muscle is activated by setting the stimu- lating electrode to 10 mA and by finding the zygomatic Results branches of the facial nerve supplying the ocular muscle. This is done by gently passing the stimulating electrode Our experience over the past 2 years is presented. over the face, with slight pressure over the superior mar- The AMR was monitored in every patient. Seventy-three gin of the zygomatic arch. Final positioning of the stimu- patients without previous decompressions underwent lating electrode is based on the location that maximizes surgery performed by 2 surgeons (R.F.S. and P.J.J.). Of the activation of the orbicularis oculi muscle. The needle these, 69 patients are free of spasm at last follow-up. electrodes are affixed to the skin in their optimal posi- Two patients required reoperation for persistent spasms tion with tape. The AMR is recorded from the mentalis despite abolishment of the AMR during the first MVD. muscle. Spontaneous activity from the mentalis muscle is Both patients were subsequently cured of HFS with a sec- not usually seen with general anesthesia. ond MVD. Both cases have been counted as failures in Once the AMR is obtained, the stimulating electrode the meta-analysis because the patients had abolishment is secured and a low limit threshold is obtained. The of the AMR at the conclusion of the first surgery, but they AMR is then recorded at that current intensity at 2.79 Hz returned with recurrent spasms. In 4 patients, the AMR with a 100-µsec pulse width. The stimulation frequency disappeared on dural opening. These 4 patients were ex- is 2–4 Hz.
Recommended publications
  • Aaem Case Report #21: Hemifacial Spasm: Preoperative Diagnosis and Intraoperative Management
    ~~ AAEM CASE REPORT #21 A 75-year-old man developed progressive involuntary hemifacial spasm. Electrophysiologic evidence of abnormal cross-transmission between neu- rons of the facial nerve was demonstrated. Electrodiagnostic studies were used to confirm the diagnosis preoperatively and determine the adequacy of vascular decompression of the facial nerve intraoperatively. Key words: hemifacial spasm nerve conduction studies, hemifacial spasm craniectomy MUSCLE & NERVE 14~213-218 1991 AAEM CASE REPORT #21: HEMIFACIAL SPASM: PREOPERATIVE DIAGNOSIS AND INTRAOPERATIVE MANAGEMENT C. MICHEL HARPER, Jr., MD Hemifacial spasm is a chronic and often progres- ments were worse with emotional stress and per- sive disorder characterized by unilateral irregular sisted during sleep. He denied any sensory distur- clonic and tonic contraction of one or more mus- bance or weakness of the face. There was a long- cles of facial expression. The condition may result standing history of partial bilateral hearing loss. from chronic compression of, or injury to, the fa- Previous treatment with phenytoin and carbam- cial The majority of patients with dis- azepine failed to improve the facial movements. abling “idiopathic” hemifacial spasm respond to surgery designed to detect and relieve vascular Physical Examination. Abnormalities were limited compression of the facial nerve at its exit from the to frequent irregular clonic contractions and inter- brainstem.“, 13,16,20,26 Electrodiagnostic studies mittent tonic spasms of the orbicularis oculi and help distinguish hemifacial spasm from other in- oris, frontalis, buccal, and mentalis muscles. There voluntary movements of the face and may help was no objective weakness of facial muscles or ab- determine when the facial nerve has been ade- normality of facial sensation.
    [Show full text]
  • Upper Lid Orbicularis Oculi Muscle Strip and Sequential Brow Suspension with Autologous Fascia Lata Is Beneficial for Selected P
    Eye (2009) 23, 1549–1553 & 2009 Macmillan Publishers Limited All rights reserved 0950-222X/09 $32.00 www.nature.com/eye Upper lid orbicularis B Patil and AJE Foss CLINICAL STUDY oculi muscle strip and sequential brow suspension with autologous fascia lata is beneficial for selected patients with essential blepharospasm Abstract Introduction Purpose Severe cases of blepharospasm Patients with severe blepharospasm, whose resistant to botulinum toxin represent a symptoms are not controlled by botulinum challenging clinical problem. Over the toxin injections, are a difficult management last 10 years, we have adopted a staged problem for whom a number of surgical options surgical management of these cases have been tried. with an initial upper lid orbicularis Two operations, in particular, have been tried; myectomy (combined with myectomy the orbicularis myectomy (or strip) and brow of procerus and corrugator supercilius as suspension. The choice of the procedure appropriate) and then 4–6 months later classically depends upon the clinical a brow suspension with autologous fascia presentation, with all types being offered the Department of lata. The aim of this study was to orbicularis myectomy except for the apraxic (also Ophthalmology, assess the outcome of this staged surgical called the pre-tarsal) type. The proposed Queen’s Medical Centre, approach. aetiology of the apraxic type is considered to Nottingham University, Materials and methods A questionnaire differ and to represent a failure of eyelid opening Nottingham, UK was sent to all patients who had undergone and is clinically characterized by the eyebrows Correspondence: AJE Foss, the procedure and the clinical records going up and not down with the spasms.
    [Show full text]
  • Blepharoplasty
    Blepharoplasty Bobby Tajudeen Brow position • medial brow as having its medial origin at the level of a vertical line drawn to the nasal alar-facial junction • lateral extent of the brow should reach a point on a line drawn from the nasal alar-facial junction through the lateral canthus of the eye • brow should arch superiorly, well above the supraorbital rim, with the highest point lying at the lateral limbus • Less arched in men • midpupillary line and the inferior brow border should be approximately 2.5 cm. The distance from the superior border of the brow to the anterior hairline should be 5 cm Eyelid aesthetics • The highest point of the upper eyelid is at the medial limbus, and the lowest point of the lower eyelid is at the lateral limbus. • Sharp canthal angles should exist, especially at the lateral canthus. • The upper eyelid orbicularis muscle should be smooth and flat, and the upper eyelid crease should be crisp. The upper lid crease should lie between 8 and 12 mm from the lid margin in the Caucasian patient. • The upper lid margin should cover 1 to 2 mm of the superior limbus, and the lower lid margin should lie at the inferior limbus or 1 mm below the inferior limbus • The lower eyelid should closely appose the globe without any drooping of the lid away from the globe (ectropion) or in toward the globe (entropion) Lid laxity and excess • A pinch test helps determine the degree of excess lid skin that is present. The snap test helps determine the degree of lower lid laxity and is useful in preoperative planning Evaluation •
    [Show full text]
  • Atlas of the Facial Nerve and Related Structures
    Rhoton Yoshioka Atlas of the Facial Nerve Unique Atlas Opens Window and Related Structures Into Facial Nerve Anatomy… Atlas of the Facial Nerve and Related Structures and Related Nerve Facial of the Atlas “His meticulous methods of anatomical dissection and microsurgical techniques helped transform the primitive specialty of neurosurgery into the magnificent surgical discipline that it is today.”— Nobutaka Yoshioka American Association of Neurological Surgeons. Albert L. Rhoton, Jr. Nobutaka Yoshioka, MD, PhD and Albert L. Rhoton, Jr., MD have created an anatomical atlas of astounding precision. An unparalleled teaching tool, this atlas opens a unique window into the anatomical intricacies of complex facial nerves and related structures. An internationally renowned author, educator, brain anatomist, and neurosurgeon, Dr. Rhoton is regarded by colleagues as one of the fathers of modern microscopic neurosurgery. Dr. Yoshioka, an esteemed craniofacial reconstructive surgeon in Japan, mastered this precise dissection technique while undertaking a fellowship at Dr. Rhoton’s microanatomy lab, writing in the preface that within such precision images lies potential for surgical innovation. Special Features • Exquisite color photographs, prepared from carefully dissected latex injected cadavers, reveal anatomy layer by layer with remarkable detail and clarity • An added highlight, 3-D versions of these extraordinary images, are available online in the Thieme MediaCenter • Major sections include intracranial region and skull, upper facial and midfacial region, and lower facial and posterolateral neck region Organized by region, each layered dissection elucidates specific nerves and structures with pinpoint accuracy, providing the clinician with in-depth anatomical insights. Precise clinical explanations accompany each photograph. In tandem, the images and text provide an excellent foundation for understanding the nerves and structures impacted by neurosurgical-related pathologies as well as other conditions and injuries.
    [Show full text]
  • MBB Lab 5: Anatomy of the Face and Ear
    MBB Lab 5: Anatomy of the Face and Ear PowerPoint Handout Review ”The Basics” and ”The Details” for the following cranial nerves in the Cranial Nerve PowerPoint Handout. • Mandibular division trigeminal (CN V3) • Facial nerve (CN VII) Slide Title Slide Number Slide Title Slide Number Blood Supply to Neck, Face, and Scalp: External Carotid Artery Slide3 Parotid Gland Slide 22 Scalp: Layers Slide4 Scalp and Face: Sensory Innervation Slide 23 Scalp: Blood Supply Slide 5 Scalp and Face: Sensory Innervation (Continued) Slide 24 Regions of the Ear Slide 6 Temporomandibular joint Slide 25 External Ear Slide 7 Temporal and Infratemporal Fossae: Introduction Slide 26 Temporal and Infratemporal Fossae: Muscles of Tympanic Membrane Slide 8 Slide 27 Mastication Tympanic Membrane (Continued) Slide 9 Temporal and Infratemporal Fossae: Muscles of Sensory Innervation: Auricle, EAC, and Tympanic Membrane Slide 10 Slide 28 Mastication (Continued) Middle Ear Cavity Slide 11 Summary of Muscles of Mastication Actions Slide 29 Middle Ear Cavity (Continued) Slide 12 Infratemporal Fossae: Mandibular Nerve Slide 30 Mastoid Antrum Slide 13 Inferior Alveolar Nerve Block Slide 31 Eustachian (Pharyngotympanic or Auditory) Tube Slide 14 Palatine Nerve Block Slide 32 Otitis Media Slide 15 Infratemporal Fossae: Maxillary Artery & Pterygoid Plexus Auditory Ossicles Slide 16 Slide 33 Chorda Tympani Nerve and Middle Ear Slide 17 Infratemporal Fossa: Maxillary Artery Slide 34 Superficial Facial Muscles: Muscles of Facial Expression Slide 18 Infratemporal Fossa: Pterygoid Plexus Slide 35 Superficial Facial Muscles: Muscles of Facial Expression Slide 19 Infratemporal Fossa: Otic Ganglion Slide 36 (Continued) Superficial Facial Muscles: Innervation Slide 20 Infratemporal Fossa: Chorda Tympani Nerve Slide 37 Superficial Facial Muscles: Innervation (Continued) Slide 21 Blood Supply to Neck, Face, and Scalp: External Carotid Artery The common carotid artery branches into the internal and external carotid arteries at the level of the superior edge of the thyroid cartilage.
    [Show full text]
  • Anatomy of the Periorbital Region Review Article Anatomia Da Região Periorbital
    RevSurgicalV5N3Inglês_RevistaSurgical&CosmeticDermatol 21/01/14 17:54 Página 245 245 Anatomy of the periorbital region Review article Anatomia da região periorbital Authors: Eliandre Costa Palermo1 ABSTRACT A careful study of the anatomy of the orbit is very important for dermatologists, even for those who do not perform major surgical procedures. This is due to the high complexity of the structures involved in the dermatological procedures performed in this region. A 1 Dermatologist Physician, Lato sensu post- detailed knowledge of facial anatomy is what differentiates a qualified professional— graduate diploma in Dermatologic Surgery from the Faculdade de Medician whether in performing minimally invasive procedures (such as botulinum toxin and der- do ABC - Santo André (SP), Brazil mal fillings) or in conducting excisions of skin lesions—thereby avoiding complications and ensuring the best results, both aesthetically and correctively. The present review article focuses on the anatomy of the orbit and palpebral region and on the important structures related to the execution of dermatological procedures. Keywords: eyelids; anatomy; skin. RESU MO Um estudo cuidadoso da anatomia da órbita é muito importante para os dermatologistas, mesmo para os que não realizam grandes procedimentos cirúrgicos, devido à elevada complexidade de estruturas envolvidas nos procedimentos dermatológicos realizados nesta região. O conhecimento detalhado da anatomia facial é o que diferencia o profissional qualificado, seja na realização de procedimentos mini- mamente invasivos, como toxina botulínica e preenchimentos, seja nas exéreses de lesões dermatoló- Correspondence: Dr. Eliandre Costa Palermo gicas, evitando complicações e assegurando os melhores resultados, tanto estéticos quanto corretivos. Av. São Gualter, 615 Trataremos neste artigo da revisão da anatomia da região órbito-palpebral e das estruturas importan- Cep: 05455 000 Alto de Pinheiros—São tes correlacionadas à realização dos procedimentos dermatológicos.
    [Show full text]
  • Periorbital Anatomy - an Essential Foundation for Blepharoplasty
    PERIORBITAL ANATOMY - AN ESSENTIAL FOUNDATION FOR BLEPHAROPLASTY William M. Ramsdell, M.D. 102 Westlake Dr, Ste 100 Austin, TX 78746 [email protected] 512-327-7779 Private Practice Periorbital Anatomy - An Essential Foundation for Blepharoplasty ABSTRACT Background Mastery of anatomy is fundamental to all surgeons. The anatomy of the eyelids and periorbital regions is unique. Because the eyes and periorbital areas are so essential to cosmetic appearance, blepharoplasty is a popular procedure. Successful blepharoplasty requires thorough knowledge of anatomical concepts. These concepts continue to evolve. Objective To develop thorough knowledge of the anatomy necessary to perform blepharoplasty. To understand anatomical relationships and age-related anatomical changes based upon physical examination. Conclusion The acquistion of knowledge regarding the structure of periorbital tissues is achievable by cosmetic surgeons dedicated to the best in patient care. Such knowledge results in a mutually beneficial surgical experience for surgeons and patients alike. Periorbital Anatomy - An Essential Foundation for Blepharoplasty PERIORBITAL ANATOMY - AN ESSENTIAL FOUNDATION FOR BLEPHAROPLASTY Comprehensive knowledge of anatomy is fundamental to any successful surgery. The anatomy of the periorbital region is unique. Successful management of this region requires not only a thorough knowledge of basic anatomical elements but also how the aging process affects these structures. The study of anatomy is a dynamic process with development of new insights on an ongoing basis. Our understanding has increased significantly over the past 20 years. This article will address fundamental anatomy of the periorbital region. UPPER EYELID ANATOMY The upper eyelid can be divided into two layers or lamellae. The anterior lamella consists of skin, orbicularis oculi muscle and the orbital septum (Figure 1).
    [Show full text]
  • Understanding the Perioral Anatomy
    2.0 ANCC CE Contact Hours Understanding the Perioral Anatomy Tracey A. Hotta , RN, BScN, CPSN, CANS gently infl ate and cause lip eversion. Injection into Rejuvenation of the perioral region can be very challenging the lateral upper lip border should be done to avoid because of the many factors that affect the appearance the fade-away lip. The client may also require injec- of this area, such as repeated muscle movement caus- tions into the vermillion border to further highlight ing radial lip lines, loss of the maxillary and mandibular or defi ne the lip. The injections may be performed bony support, and decrease and descent of the adipose by linear threading (needle or cannula) or serial tissue causing the formation of “jowls.” Environmental puncture, depending on the preferred technique of issues must also be addressed, such as smoking, sun the provider. damage, and poor dental health. When assessing a client Group 2—Atrophic lips ( Figure 2 ): These clients have for perioral rejuvenation, it is critical that the provider un- atrophic lips, which may be due to aging or genetics, derstands the perioral anatomy so that high-risk areas may and are seeking augmentation to make them look be identifi ed and precautions are taken to prevent serious more youthful. After an assessment and counseling adverse events from occurring. as to the limitations that may be achieved, a treat- ment plan is established. The treatment would begin he lips function to provide the ability to eat, speak, with injection into the wet–dry junction to achieve and express emotion and, as a sensory organ, to desired volume; additional injections may be per- T symbolize sensuality and sexuality.
    [Show full text]
  • Imaging of Neurovascular Compression Syndromes: Trigeminal Neuralgia, Hemifacial Spasm, Vestibular Paroxysmia, and Glossopharyngeal Neuralgia
    REVIEW ARTICLE Imaging of Neurovascular Compression Syndromes: Trigeminal Neuralgia, Hemifacial Spasm, Vestibular Paroxysmia, and Glossopharyngeal Neuralgia X S. Haller, X L. Etienne, X E. Ko¨vari, X A.D. Varoquaux, X H. Urbach, and X M. Becker ABSTRACT SUMMARY: Neurovascular compression syndromes are usually caused by arteries that directly contact the cisternal portion of a cranial nerve. Not all cases of neurovascular contact are clinically symptomatic. The transition zone between the central and peripheral myelin is the most vulnerable region for symptomatic neurovascular compression syndromes. Trigeminal neuralgia (cranial nerve V) has an incidence of 4–20/100,000, a transition zone of 4 mm, with symptomatic neurovascular compression typically proximal. Hemifacial spasm (cranial nerve VII) has an incidence of 1/100,000, a transition zone of 2.5 mm, with symptomatic neurovascular compression typically proximal. Vestibular paroxysmia (cranial nerve VIII) has an unknown incidence, a transition zone of 11 mm, with symptomatic neurovascular compression typically at the internal auditory canal. Glossopharyngeal neuralgia (cranial nerve IX) has an incidence of 0.5/100,000, a transition zone of 1.5 mm, with symptomatic neurovascular compression typically proximal. The transition zone overlaps the root entry zone close to the brain stem in cranial nerves V, VII, and IX, yet it is more distal and does not overlap the root entry zone in cranial nerve VIII. Although symptomatic neurovascular compression syndromes may also occur if the neurovascular contact is outside the transition zone, symptomatic neurovascular compression syndromes are more common if the neurovascular contact occurs at the transition zone or central myelin section, in particular when associated with nerve displacement and atrophy.
    [Show full text]
  • Intravascular Embolization of a Cerebellar Arteriovenous Malformation for Treatment of Hemifacial Spasm
    403 Intravascular Embolization of a Cerebellar Arteriovenous Malformation for Treatment of Hemifacial Spasm 1 3 1 1 1 4 Peter J. Yang, - Randall T. Higashida, Van V. Halbach, Grant B. Hieshima, and Charles B. Wilson Hemifacial spasm consists of involuntary contractions of starting with the orbicularis oculi muscle and continuing down­ the facial muscles, usually caused by vascular compression ward to involve all the muscles of the face [1-5]. It is caused of cranial nerve VII , near its exit zone from the brainstem [1- by hyperactive dysfunction of the facial nerve and can have a 7]. Arteriovenous malformations (AVMs) are a rare cause of variety of causes. The most common cause is vascular this condition [2, 3]. We report a case of hemifacial spasm compression by a small artery or vein at the exit zone for the caused by an extensive cerebellar AVM , which was success­ seventh nerve [1-7]. This portion of the nerve appears to be fully treated by intravascular embolization. particularly susceptible to compression because of an ana­ tomically discernible junction where the thinner central myelin is replaced by thicker, peripheral myelin [4, 5]. Other causes Case Report for hemifacial spasm include aneurysms, AVMs, and tumors of the cerebellopontine angle [2 , 8, 9]. Decompression of the A 58-year-old man presented with a chief complaint of right hemi­ nerve will usually relieve the symptoms. facial spasm occurring 15-20 times a day for 2 months. He also complained of a right-sided bruit present for 1 year, and intermittent Larger posterior fossa AVMs are difficult to treat surgically dizziness 10-15 times a day for 3-4 months.
    [Show full text]
  • Inferior Oblique Muscle of the Eye: Its Fetal Development with Special Reference to Understanding of the Frequent Variants in Adults
    ONLINE FIRST This is a provisional PDF only. Copyedited and fully formatted version will be made available soon. ISSN: 0015-5659 e-ISSN: 1644-3284 Inferior oblique muscle of the eye: its fetal development with special reference to understanding of the frequent variants in adults Authors: Z. W. Jin, S. Umeki, Y. Takeuchi, M. Yamamoto, G. Murakami, S. Abe, J. F. Rodríguez-Vázquez DOI: 10.5603/FM.a2021.0043 Article type: Original article Submitted: 2021-03-13 Accepted: 2021-04-09 Published online: 2021-04-28 This article has been peer reviewed and published immediately upon acceptance. It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Folia Morphologica" are listed in PubMed. Powered by TCPDF (www.tcpdf.org) Inferior oblique muscle of the eye: its fetal development with special reference to understanding of the frequent variants in adults Z.W. Jin et al., Development of the inferior obliquus Z.W. Jin1, S. Umeki2, Y. Takeuchi2, M. Yamamoto2, G. Murakami2, 3, S. Abe2, J.F. Rodríguez-Vázquez4 1Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, China 2Department of Anatomy, Tokyo Dental College, Tokyo, Japan 3Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan 4Department of Anatomy and Embryology, School of Medicine, Complutense University, Madrid, Spain Address for correspondence: Z.W. Jin, MD, PhD, Department of Anatomy, Wuxi School of Medicine, Jiangnan University, 1800 Lihu Avenue, Wuxi, Jiangsu, 214122, China, tel: +86-510-8519-7079, fax: +86-510-8519-3570, e-mail: [email protected] ABSTRACT To provide better understanding of frequent variations of the inferior oblique (IO) of adult extraocular muscles, we observed sagittal and horizontal histological sections of the eye and orbits from 32 fetuses (approximately 7-34 weeks of gestational age; 24-295 mm of crown-rump length).
    [Show full text]
  • The Role of Jankovic Spasm Grading, Orbicularis Oculi Muscle Function
    Acta Scientific Ophthalmology (ISSN: 2582-3191) Volume 3 Issue 8 August 2020 Research Article The Role of Jankovic Spasm Grading, Orbicularis Oculi Muscle Function and Functional Improvement Scale Pre-and Post-Treatment in Dosing Botulinum Toxin A in Treatment of Essential Blepharospasm, Meige’s Syndrome and Hemifacial Spasm Bastola P1* and Koirala S2 Received: June 12, 2020 1Associate Professor, Consultant Ophthalmologist and Oculoplastic Surgeon, Published: July 10, 2020 Botulinum Toxin A Expert, Kathmandu, Nepal © All rights are reserved by Bastola P and 2Head of Department, Department of Neurology, DM Neurologist, National Koirala S. Academy of Medical Sciences, Kathmandu, Nepal *Corresponding Author: Bastola P, Associate Professor, Consultant Ophthalmologist and Oculoplastic Surgeon, Botulinum Toxin A Expert, Kathmandu, Nepal. DOI: 10.31080/ASOP.2020.03.0144 Abstract Background: Botulinum Toxin A (BTX A) is a proven medication used in neurological disorders like Meige’s syndrome (MS), essen- tial blepharospasm (ES) and hemifacial spasm (HS). Jankovic spasm grading is a time trusted grading system to detect the severity of these movement disorders pre-treatment. Orbicularis oculi muscle weakness and functional improvement ratings post treatment areAim/Objective: trusted guidelines to judge the efficacy of BTX A. grading pre-treatment and orbicularis oculi muscle weakness and functional impairment improvement post treatment. The study aimed to find out the correct dosing of BTX A in treating cases of MS, ES and HS using Jankovic Spasm Methods: This was a hospital based, interventional, prospective study. All diagnosed consecutive patients of HS, ES and MS attend- ing the neuro-Ophthalmologic/oculoplastic clinic, general outpatient department of Ophthalmology and or referred diagnosed cases were enrolled for the study, an informed consent was taken from all the patients before the treatment for medico-legal issues.
    [Show full text]