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[Synchronized hemifacial spasm induced by sound stimulation].

Y Yamamoto, A Kondo, J Hanakita

    No Shinkei Geka. Neurological Surgery
    |August 1, 1985
    PubMed
    Summary

    A patient with recurrent hemifacial spasm developed sound-triggered spasms after initial surgery. A second surgery revealed a new arterial compression, resolving the spasms and sound-evoked facial muscle activity.

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    Area of Science:

    • Neurology
    • Neurosurgery

    Background:

    • Hemifacial spasm (HFS) is a neuromuscular disorder characterized by involuntary contractions of facial muscles.
    • Microvascular decompression (MVD) is a primary surgical treatment for HFS, involving the separation of compressing blood vessels from cranial nerves.

    Observation:

    • A 42-year-old woman with a 10-year history of HFS, successfully treated with MVD, experienced recurrence 7 months post-surgery.
    • The recurrent HFS manifested not only involuntarily but also synchronously with auditory stimulation (90 dB click sound).
    • Electromyography (EMG) confirmed abnormal, high-amplitude facial muscle discharges evoked by sound, which ceased upon sound discontinuation.

    Findings:

    • A second MVD surgery identified a different arterial loop compressing the facial nerve at the root entry zone, more proximal than the initial site.

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  • Complete decompression of the facial nerve resulted in the complete resolution of both involuntary and sound-evoked hemifacial spasms.
  • Postoperative EMG showed no abnormal discharges in response to auditory stimulation.

    • Implications:

    • This case highlights the possibility of recurrent or new neurovascular compression sites after initial MVD for HFS.
    • The development of sound-evoked HFS suggests a dynamic interaction between auditory pathways and facial nerve function, potentially mediated by aberrant ephaptic transmission.
    • Successful surgical re-intervention underscores the importance of thorough exploration and identification of all offending vessels in recurrent cases.