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Hemifacial spasm caused by a pilocytic astrocytoma of the fourth ventricle

D I Sandberg1, M M Souweidane

  • 1Division of Neurosurgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York 10021, USA.

Pediatric Neurology
|December 2, 1999
PubMed

Insights

A rare pediatric case of hemifacial spasm presented as the initial symptom of a fourth ventricle pilocytic astrocytoma. Tumor resection significantly alleviated the child's hemifacial spasm, highlighting a rare but important association.

Area of Science:

  • Pediatric Neurology
  • Neuro-oncology
  • Cerebrovascular Disorders

Background:

  • Hemifacial spasm (HFS) is a focal neurological disorder characterized by involuntary contractions of facial muscles, typically affecting adults.
  • While often idiopathic or caused by vascular compression of the facial nerve, HFS can rarely be a symptom of central nervous system pathology.
  • Brain tumors, particularly those in the posterior fossa, are an uncommon etiology for HFS, especially in pediatric populations.

Observation:

  • This report details an 11-year-old male presenting with hemifacial spasm as the sole initial neurological sign.
  • Diagnostic imaging revealed a pilocytic astrocytoma located within the fourth ventricle.
  • The patient underwent surgical resection of the fourth ventricle tumor.

Findings:

  • Postoperatively, the child experienced a substantial reduction in the severity and frequency of hemifacial spasm.
  • This case contributes to the limited literature on pediatric hemifacial spasm, with this being the fifth reported case in a child.
  • Notably, three of the five pediatric cases of HFS have been associated with fourth ventricle tumors, underscoring a potential link.

Implications:

  • This case emphasizes the importance of considering central nervous system pathology, including brain tumors, in the differential diagnosis of hemifacial spasm in children.
  • The findings suggest that pilocytic astrocytomas of the fourth ventricle may present with HFS and that surgical intervention can be effective in symptom management.
  • Further investigation into the neuroanatomical or neurophysiological mechanisms linking fourth ventricle tumors to hemifacial spasm in pediatric patients is warranted.

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