Hemifacial spasm associated with a cerebellopontine angle arachnoid cyst in a young adult

doi:10.1016/0090-3019(92)90155-G

Surgical Neurology

Volume 37, Issue 4, April 1992, Pages 289-292

https://doi.org/10.1016/0090-3019(92)90155-G Get rights and content

Abstract

There are no reported cases of hemifacial spasm associated with an arachnoid cyst in the literature. We report the first case of hemifacial spasm with an ipsilateral cerebellopontine angle arachnoid cyst in a 25-year-old man. The patient underwent evacuation of the arachnoid cyst by a partial membranectomy without any beneficial effect, and finally got rid of the hemifacial spasm by reexploration and microvascular decompression of the facial nerve. The operative findings and results revealed that the cyst produced deviation of the ipsilateral posterior inferior cerebellar artery, which was secondarily in contact with the root exit zone of the facial nerve.

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Cited by (52)

Arachnoid Cyst of the Cerebellopontine Angle: A Systematic Literature Review
2024, World Neurosurgery
The role of surgical management of arachnoid cyst (AC) of the cerebellopontine angle (CPA) is uncertain. This topic has remained controversial with varying contradictory recommendations in the literature, which is limited to mostly case reports. We aimed to provide a comprehensive summary and analysis of symptoms, operative techniques, outcomes, and recurrence of all available surgical cases of AC of the CPA to date.
A systematic literature search was performed in May 2022 querying several scientific databases. Inclusion criteria specified all studies and case reports of patients with AC located at the CPA for which any relevant surgical procedures were performed.
A total of 55 patients from the literature and 5 treated at our institution were included. Mean patient age was 29 years (range, 0.08–79 years), with nearly twice (1.7×) as many female as male patients (37 female, 22 male). Headaches (35%), hearing loss (30%), vertigo (22%), and ataxia (22%) were the most common presentations. Following surgery, 95% experienced symptom improvement, with complete resolution in 64%. Of patients with hearing loss, 44% reported a return to normal. The rate of mortality was 1.69%, and 10% of tumors recurred (mean follow-up 2.3 years [range, 0–15 years].
Symptomatic AC of the CPA is rare. It exhibits a proclivity for females and commonly manifests with headache, hearing loss, vertigo, and ataxia. While careful selection for surgical candidacy is needed and intervention should be reserved for patients with severe symptoms, surgical decompression is an effective tool for symptom alleviation and recovery.
Quadrigeminal cistern arachnoid cyst as a probable cause of hemifacial spasm
2021, Radiology Case Reports
Citation Excerpt :
The close relationship between the left VA and the proximal segment of the facial nerve that was found on the preoperative imaging did not show any significant change (Fig. 5). Arachnoid cysts arising in the cerebellopontine angle have been documented to cause hemifacial spasm and trigeminal pain [14–16]. However, to the best of our knowledge, ACQC-associated hemifacial spasm has not been reported.
Arachnoid cysts arising in the quadrigeminal cistern (ACQCs) are uncommon. A 68-year-old woman presented with an unsteady gait, facial spasm, and cerebellar ataxia. Non-contrast head computed tomography showed a cystic mass centered in the quadrigeminal cistern accompanying ventriculomegaly. On MRI, the cyst appeared hypointense on T1- and hyperintense on T2-weighted sequence. There was no restricted diffusion on diffusion-weighted imaging. The cerebral aqueduct was obstructed and the prepontine cistern was narrowed. The left vertebral artery (VA) coursed adjacent to the facial nerve at its origin. The patient underwent neuroendoscopic fenestration of the posterior wall of the third ventricle and ventral wall of the ACQC. Postoperatively, the patient's symptoms resolved. MRI showed a considerable reduction in the ACQC and expansion of the prepontine cistern, whereas the relationship between the left VA and the proximal segment of the facial nerve did not change. We assumed that the pre-existing close relationship between the VA and facial nerve might have been aggravated by the anterior displacement of the brainstem, thus causing the facial spasm.
Hemifacial Spasm Caused by Small Epidermoid Tumor, Misinterpreted as Delayed Secondary Hemifacial Spasm Caused by Vestibular Schwannoma Treated with Gamma Knife Surgery
2019, World Neurosurgery
Citation Excerpt :
Many authors have suggested that the surrounding or displaced vessels of tumor compressing the facial nerve REZ triggered the HFS.8,12,13 Another prominent hypothesis is that CPA tumors may direct compress or distort the facial nucleus.14,15 In our case, the patient was treated with GKS for VS more than 10 years before she suffered from the HFS.
Hemifacial spasm (HFS), one of the most common hyperactive cranial rhizopathies, is a disorder characterized by spontaneous, intermittent, and repetitive contraction of unilateral facial muscle. The most common cause of HFS is a mechanical compression of the facial nerve at the root exit zone (REZ) by blood vessels located in the brainstem. The incidence of cerebellopontine angle (CPA) tumor−induced HFS ranges from 0.3%−2.5% of all patients with HFS, and the incidence of epidermoid cyst among such tumors is extremely rare (0.2% to 0.25%). We present a patient manifesting HFS induced by a small epidermoid cyst who underwent Gamma Knife surgery (GKS) for ipsilateral vestibular schwannoma (VS) more than 10 years ago.
A 59-year-old female was admitted to our hospital with HFS. Ten years before admission, the patient underwent GKS for ipsilateral VS. Enhanced brain magnetic resonance imaging demonstrated that the volume of VS was not increased. Also, no definitive mechanical compression of the facial nerve REZ by blood vessels was detected. We concluded that HFS was secondary to the VS treatment by GKS and decided to operate to remove the tumor and identify REZ. A standardized lateral suboccipital retrosigmoid approach was performed. The cochlear nerve was encased by a tumor mass, and the posterior inferior cerebellar artery (PICA) was displaced by the mass. During tumor excision, we ensured that the VS and displaced PICA did not directly compress the REZ. Interestingly, an unexpected lesion was found with a yellowish viscous mass located between the sixth nerve and ventral side of the seventh nerve REZ. After the tumor removal, a small piece of Teflon was inserted between the PICA and REZ of the facial nerve. Postoperatively, the patient experienced no HFS or facial nerve dysfunction. Histopathologic examination of the lesion revealed an epidermoid cyst.
We should consider various possibilities for the cause of HFS and review brain imaging meticulously if patients were treated for CPA tumor with GKS a long time ago and the delayed HFS occurred without changes in tumor volume. HFS induced by epidermoid cyst is rare. Therefore it is critical for the neurosurgeon to ensure the absence of any abnormal contact with the REZ of the facial nerve during surgery for HFS induced by CPA tumors.
Surgical Treatment of Secondary Hemifacial Spasm: Long-Term Follow-Up
2019, World Neurosurgery
Citation Excerpt :
With respect to tumor, many authors have suggested that it is the vascular compression under the tumor that causes HFS.11,13 Other experts have suggested that tumors may compress or distort either the root exit zone of the nerve or the facial nucleus.12,14 In our study, after the tumors were resected, we could find the responsible vessels in up to 76.92% (20 out of 26) of patients.
Hemifacial spasm (HFS) is generally caused by the root exit zone of the facial nerve compressed by an overlying arterial loop. HFS can also be caused by various types of tumor, aneurysm, or arteriovenous malformation. We retrospectively analyzed patients to evaluate possible differences in the demographic and clinical features between primary and secondary HFS.
A retrospective study of 3140 cases of HFS treated in our department between January 2009 and June 2016. Among the 3140 total cases, 26 patients had secondary HFS.
The 26 tumors of secondary HFS included 11 meningiomas, 8 epidermoid cysts, and 7 vestibular schwannomas. Compared to those with idiopathic HFS, those patients with tumor-induced HFS were significantly younger (P < 0.05). Secondary HFS tended to have responsible vessels, and were observed in 20 (76.92%) of these 26 patients. The long-term effective rate of operation was 84% in the secondary HFS group and was 96.45% in the primary HFS group (P < 0.05); the incidence rate of complication was 12% in the secondary HFS group and was 3.06% in the primary HFS group (P < 0.05).
In cases of secondary HFS, facial nerves of most patients were compressed by blood vessels, so microvascular decompression after tumor resection plays an important role. We should examine the entire nerve root for possible vascular compression.
Preliminary Study on the Relationship Between Inflammation and Hemifacial Spasm
2019, World Neurosurgery
Citation Excerpt :
However, in addition to compression of the vessel itself, another contributing factor leading to HFS is adhesion and traction to vessel of adjacent arachnoid membranes. Some studies have stated that only complete separation and dissection of arachnoid membranes can result in sufficient MVD for HFS.6-9 Moreover, thickened, opaque, and sticky arachnoid membranes have sometimes been observed during surgery for HFS.
Complete pathogenesis of hemifacial spasm (HFS) is unknown. In some patients with HFS, thickened, opaque, and sticky arachnoid membranes have been found during microvascular decompression procedures. This phenomenon indicates a possible relationship between inflammation and HFS. The aim of this study was to explore the role of inflammation in pathogenesis of HFS.
Levels of interferon-γ, interleukin-2 receptor, interleukin-6 (IL-6), interleukin-8, interleukin-10, and tumor necrosis factor α and white blood cell (WBC), neutrophil, and lymphocyte counts were compared between patients with HFS, patients with lumbar disc herniation, and healthy control subjects. A receiver operating characteristic curve analysis was performed to evaluate the diagnostic significance of peripheral blood inflammatory markers for HFS. All the inflammatory markers were further analyzed by single and multiple logistic regression analysis.
Patients with HFS had greater IL-6, interleukin-8, white blood cell count, and neutrophil count than patients with lumbar disc herniation and healthy control subjects. Area under curve values of IL-6, white blood cell count, and neutrophil count were >0.8. Multiple logistic regression analysis indicated that only interleukin-2 receptor and IL-6 were relevant to HFS.
Inflammation is relative to HFS. IL-6 may be 1 of many factors involved in pathogenesis of HFS.
Imaging in Otolaryngology
2018, Imaging in Otolaryngology

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View full text

Hemifacial spasm associated with a cerebellopontine angle arachnoid cyst in a young adult

Abstract

Hemifacial spasm: a note on the etiology in two cases

J Neurosurg

Tic convulsif: results in 11 cases treated with microvascular decompression of the fifth and seventh cranial nerves

J Neurosurg

Arachnoid cysts of the cerebellopontine angle

J Neurosurg

Microsurgical treatment of hemifacial spasm

West J Med

Hemifacial spasm

Neurol Neurosurg

Microsurgical exploration and decompression of the facial nerve in hemifacial spasm

Curr Top Surg Res

Hemifacial spasm in young people treated with microvascular decompression of the facial nerve

Neurosurgery

Infantile hemifacial spasm

Arch Neurol