ABSTRACT
Hemifacial spasm (HFS) is a clinical syndrome characterized by unilateral facial nerve dysfunction. The usual cause involves vascular compression of the seventh cranial nerve, but compression by an artery passing through the facial nerve is very unusual. A 20-year-old man presented with left facial spasm that had persisted for 4 years. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery (AICA) was revealed on magnetic resonance angiography. During microvascular decompression surgery, penetration of the distal portion of the facial nerve root exit zone by the AICA was observed. At the penetrating site, the artery was found to have compressed the facial nerve and to be immobilized. The penetrated seventh cranial nerve was longitudinally split about 2 mm. The compressing artery was moved away from the penetrating site and the decompression was secured by inserting Teflon at the operative site. Although the facial spasm disappeared in the immediate postoperative period, the patient continued to show moderate facial weakness. At postoperative 12 months, the facial weakness had improved to a mild degree. Prior to performing microvascular decompression of HFS, surgeons should be aware of a possibility for rare complex anatomy, such as compression by an artery passing through the facial nerve, which cannot be observed by modern imaging techniques.
Subject(s)
Humans , Young Adult , Arteries , Decompression , Facial Nerve , Hemifacial Spasm , Magnetic Resonance Angiography , Microvascular Decompression Surgery , Polytetrafluoroethylene , Postoperative Period , SpasmABSTRACT
Based on the recently proposed Chinese ischemic stroke subclassification (CISS) system, intracranial branch atheromatous disease (BAD) is divided into large artery atherosclerosis (LAA) and penetrating artery disease (PAD). In the current retrospective analysis, we compared the general characteristics of BAD-LAA with BAD-PAD, BAD-LAA with non-BAD-LAA and BAD-PAD with non-BAD-PAD. The study included a total of 80 cases, including 45 cases of BAD and 35 cases of non-BAD. Subjects were classified using CISS system: BAD-LAA, BAD-PAD, non-BAD-LAA and non-BAD-PAD. In addition to analysis of general characteristics, the correlation between the factors and the two subtypes of BAD was evaluated. The number of cases included in the analysis was: 32 cases of BAD-LAA, 13 cases of BAD-PAD, 21 cases of non-BAD-LAA, and 14 cases of non-BAD-PAD. Diabetes mellitus affected more non-BAD-LAA patients than BAD-LAA patients (P=0.035). In comparison with non-BAD-PAD, patients with BAD-PAD were younger (P=0.040), had higher initial NIHSS score (P<0.001) and morbidity of ischemic heart disease (P=0.033). Within patients with BAD, the PAD subtype was associated with smoking (OR=0.043; P=0.011), higher low-density lipoprotein (OR=5.339; P=0.029), ischemic heart disease (OR=9.383; P=0.047) and diabetes mellitus (OR=12.59; P=0.020). It was concluded that large artery atherosclerosis was the primary mechanism of BAD. The general characteristics showed no significant differences between the CISS subtypes of LAA and PAD within BAD, as well as between the BAD and non-BAD within LAA subtype. Several differences between PAD subtypes of BAD and non-BAD were revealed.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Brain Ischemia , Pathology , China , Stroke , PathologyABSTRACT
Objective To investigate the imaging characteristics, clinical features and outcomes of penetrating ar-tery disease (PAD) cerebral infarction. Methods One hundred cases of cerebral infarction were divided into 44 cases of PAD group and 56 cases of LAA (large artery atherosclerosis ) group by brain MRI and neck CTA, or DSA neck artery ultrasound. The clinical features, imaging characteristics, outcome and progressive motor deficits(PMD) were compared between PAD cerebral infarction and large artery atherosclerosis (LAA) cerebral infarction. Results There were For-ty-four (44%) cases of PAD cerebral infarction, 56 (56%) cases of LAA cerebral infarction according to 2011 Chinese ischemic stroke subclassification (CISS). The smoking, drinking and TIA histories was significantly less in PAD group (27.27%) than in LAA group (50%) (P=0.021,0.023 and 0.025 respectively,);compared with LAA group, PMD occured in PAD group more frequently. (56.82% vs. 30.36%, P=0.008); lesions were located in the lateral ventricles in most PAD group which was significantly different from LAA group (52.27% vs. 21.43%, P=0.001). Modified Rankin Scale, (mRS) was not significantly different between two groups (1.43 ± 1.17 vs. 1.43 ± 1.45, P=0.99) at 3 months. Conclu-sions Patients with PAD cerebral infarction have PMD at early stage but have good prognosis at three months.
ABSTRACT
Objective To investigate the safety and efficacy of intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rtPA)in patients with isolated penetrating artery territory infarct (IPAI).Methods Data of retrospectively collected clinical,laboratory,and radiological from 75 consecutive patients with acute ischemic stroke treated with intravenous rtPA therapy from June 2009 to April 2011.Etiological classification was carried out according to the Chinese Ischemic Stroke Classification of Subgroups(CISS).The rates of hemorrhagic transformation(HT)and clinical outcomes of patients were compared between IPAI group and non-IPAI group.Results All 75 patients with mean age of 67.4years and 25(33.3％)fenale,were treated with intravenous rtPA.Before treatment,their average score of the National Institutes of Health Stroke Scale(NIHSS)was 12.3 ± 6.4,and mean length of time from onset to treatment was 239.6 ±97.5 minutes.After thrombolytic therapy,the radiological HT was found in 24 patients(32％).Symptomatic intracraneal hemorrhage(ICH)occurred in 4 patients(5.3％).Of 22 (29.3％)patients with IPAI,only one experienced HT.Logistic regression analysis suggested that IPAI wasan individualized predictor used alone for determining the low risk of HT.In the patients with IPAI,82％ of them had an individual clinical outcome(mRS ＜ 2)one month after onset,and the neurological outcomes were better in patients with IPAI than those in patients with non-IPAI(P ＜ 0.01).Conclusions The risk of hemorrhagic complication was low and the clinical outcome was good in patients with isolated penetrating artery territory infarct after intravenous thrombolytic therapy with rtPA.Imaging diagnosis of IPAI might facilitate the treatment with rtPA in this cohort of patients.
ABSTRACT
Objective To study the clinical efficacy of island skin flap in the repair of skin and subcutaneous soft tissue defects caused by excision of malignant tumour in the skin. Methods Island skin flaps with the main artery and its penetrating branches were used to repair the skin and soft tissue defects in different sites after malignant tumour removal. A total of 5 cases were repaired, in which 2 cases were in the face, 2 in limb and one in wall of the chest. Results Among the 5 cases, one was repaired with island skin flaps with the main artery, and another 4 were repaired with island skin flaps with the penetrating arteries. Follow-up for one to 5 years showed that the appearance and function in the repaired sites were normal without blood flow disturbance and dysfunction of the island skin flap, and no recurrence of the tumors except one case. Conclusion The island skin flap with main artery, especially one with its penetrating branches, is a good option to repair the defect caused by removal of malignant tumors with high rate of success, better appearance and minor damage to the donor site.