Hemifacial Spasm Clinical Trial
Official title:
Microvascular Decompressive Surgery for Hemifacial Spasm: Nuances of Technique and Outcome
- Review the clinical outcomes of Micro vascular decompression of Hemi facial Spasm.
- Assess safety and efficacy of Micro vascular decompression.
- Improve the outcome of these patients and decease rate of recurrence and complications.
Hemi facial spasm (HFS), a term described in 1905 by Babinski but first reported by Schultz
in 1875, is a highly morbid movement disorder characterized by intermittent involuntary
movement of muscles innervated by the facial nerve.
(HFS) affects roughly 10 in 100,000 individuals in fifth or sixth decades of life.
Primary HFS is commonly attributed to vascular loops compressing the seventh cranial nerve at
its exit zone from the brainstem. The facial nerve compression is thought to lead to ephaptic
transmission and to hyperactivity of the facial nucleus, resulting in the involuntary facial
movements.
Secondary HFS frequently follows peripheral facial palsy or may arise from facial nerve
damage produced by tumours, demyelinating disorders, traumatisms, and infections accounting
for 1-2 & of HFS.
Over four in five primary HFS cases involve either anterior or posterior inferior cerebellar
artery as the primary offender although vertebral artery, multiple vessels and veins may be
involved.
EMG recordings confirm the diagnosis by showing a typical electrophysiological signature:
clonic facial muscle contractions, hyperactivity, and synkinesis, lateral spread evoked
responses.
Imaging can be useful for confirming that HFS is primary in nature and due to a neurovascular
compression. In most cases (95% of the patients) the compressive vessel, generally an artery,
is seen on MRI combined with MR-Angiography (MRA). High resolution T2-sequence is to be used
to get good delineation of the facial nerve.
Many treatments for HFS have been reported, including pharmacological agents, botulinum toxin
injection, facial nerve blockage, physical therapy, radiofrequency ablation, acupuncture, as
well as facial nerve combing and microvascular decompression (MVD).
However, while MVD is effective, there are still significant postoperative complications.
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