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Hemifacial spasm and craniovertebral anomaly
F B Maroun1, J C Jacob, B K Weir
1Division of Neurosurgery, Memorial University of Newfoundland, St. John's.
Insights
Congenital craniovertebral junction anomalies can cause disabling hemifacial spasm (HFS). While bony decompression offered temporary relief in one case, both patients ultimately required microvascular decompression for persistent HFS.
Area of Science:
- Neurosurgery
- Neurology
- Anatomy
Background:
- Congenital anomalies of the craniovertebral junction are rare and can present with diverse neurological symptoms.
- Hemifacial spasm (HFS) is a neurological disorder characterized by involuntary contractions of facial muscles, often debilitating for patients.
Observation:
- This report details two patients with craniovertebral junction anomalies leading to severe hemifacial spasm.
- One patient experienced a two-year remission of HFS after undergoing simple bony decompression of the craniovertebral junction.
Findings:
- The initial positive response to bony decompression in one patient suggests a potential, albeit temporary, role of structural compression in HFS pathogenesis.
- Ultimately, both patients required microvascular decompression (MVD) at the facial nerve root entry zone for sustained relief of hemifacial spasm.
Implications:
- These cases highlight the complex etiology of hemifacial spasm, particularly when associated with craniovertebral junction abnormalities.
- Microvascular decompression remains a definitive treatment for drug-resistant hemifacial spasm, even in the context of underlying congenital anomalies.
Abstract:
Two patients with congenital anomaly of the craniovertebral junction causing disabling hemifacial spasm (HFS) are presented. In one patient, complete cessation of the HFS occurred for a period of two years following simple bony decompression of the craniovertebral junction raising unanswered questions as to the exact pathogenesis of HFS. Eventually both patients required microvascular decompression at the root entry zone of the facial nerve.