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NEUROVASCULAR COMPRESSION |
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HEMIFACIAL SPASM |
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Hemifacial spasm is a rare
condition of the facial nerve (cranial nerve VII). It presents as uncontrollable
half sided contractions of the mimic facial muscles around the mouth and eye
which are called synkenisia. The contractions can be twitches or lasting
tonic cramps which entirely distort one side of the face. Usually hemifacial
spasm is not painful. The affected person suffers mainly from a loss of
social status and integration (i.e. setback in career, isolation). Tumors along the facial nerve,
inflammatory changes or injuries to the nerve as well as pathologic changes
of the brain stem can be causes of hemifacial spasm in rare cases. In most
cases we find a neurovascular
compression of the nerve at its root entry zone in the
posterior cranial fossa. MRI is the diagnostic procedure of choice. A
high-resolution MRI together wit 3D-image processing can detect a
neurovascular compression. Medical treatment of hemifacial
spasm includes carbamazepine, phenytoin, and Baclofen, but is not very
effective. Injections of botulinum toxin in the affected facial muscle causing
a temporary paralysis of the corresponding muscles serve as symptomatic
trearment. The effect usually subsides after a certain period of time and the
symptoms return. Repetition of this procedure can result in permanent
weakness of the affected muscles or antibodies against botox develop, which
reduce the effectiveness dramatically. Microvascular decompression
is the causal therapy for the neurovascular compression in hemifacial spasm.
In 80-90% of the cases this procedure results in permanent success without a
loss of functionality. Destructive methods such as severing the nerve causing
functional disorder should be avoided. |
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NVCHOME.COM |
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R. NARAGHI |
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