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[Cerebellopontile angle epidermoid presenting as hemifacial spasm]
No to Shinkei = Brain and Nerve
|October 1, 1983
Summary
A rare cerebellopontine angle epidermoid cyst caused hemifacial spasm in a patient undergoing microvascular decompression. Surgical removal resolved the spasm, highlighting the importance of considering epidermoid tumors in such cases.
Area of Science:
- Neurosurgery
- Neurology
- Oncology
Background:
- Hemifacial spasm (HFS) is typically treated with microvascular decompression (MVD).
- Cerebellopontine angle (CP angle) epidermoid cysts are rare tumors that can compress cranial nerves.
- Preoperative imaging may not always detect CP angle epidermoid cysts.
Observation:
- A 48-year-old woman presented with a 4-year history of left hemifacial spasm.
- Preoperative CT scans showed a subtle low-density area in the left CP angle, initially considered within normal limits.
- During surgery for MVD, a CP angle epidermoid cyst was discovered extending from the lower cranial nerves to the midbrain.
Findings:
- The CP angle epidermoid cyst was successfully removed via the same craniectomy.
- Postoperative follow-up of 16 months showed complete resolution of hemifacial spasm without neurological deficits.
- CP angle epidermoid cysts causing HFS are exceedingly rare, accounting for only 1.2% of HFS cases in literature reviews and 0.24% in the authors' MVD experience.
Implications:
- CP angle epidermoid cysts should be considered in the differential diagnosis of hemifacial spasm, especially when planning MVD.
- Early diagnosis and surgical intervention can lead to favorable outcomes for HFS caused by epidermoid tumors.
- This case underscores the importance of thorough intraoperative evaluation during MVD for HFS.