Clinical, anatomical, and histological features of the rhomboid lip and considerations for surgery using a retrosigmoid approach: a retrospective study.

OBJECTIVE: The rhomboid lip is a neural tissue encountered during cerebellopontine angle surgery, with differing shape and extent among individuals. This study aimed to investigate the variation of rhomboid lips during posterior fossa surgery. METHODS: In this retrospective study, we examined posterior cranial fossa surgeries performed using a retrosigmoid approach. Rhomboid lips were classified according to thickness, extent, and appearance, with some subjected to histological analysis. T2-weighted magnetic resonance imaging (MRI) of rhomboid lips was conducted. RESULTS: Among 304 surgeries, rhomboid lips were observed in 75 patients who underwent schwannoma or meningioma resection, facial spasm-related neurovascular decompression, and other surgeries (37, 2, 32, and 4 patients, respectively). Rhomboid lips were categorized based on apparent thickness: thin membranous type, resembling an arachnoid membrane, and thick parenchymal type. Rhomboid lip extension was classified by position relative to the choroid plexus: non-extension, lateral extension, and jugular foramen (41, 22, and 12 patients, respectively). Veins were observed on the rhomboid lip surface in 37 cases. The rhomboid lip was visible in only one case (parenchymal jugular foramen type) on MRI. Histologically, the rhomboid lip comprised an ependymal cell layer, a glial layer, and connecting tissue. The glial layer thickness determined the rhomboid lip thickness, which was greater in the parenchymal type than in the membrane type. In 42 patients, the rhomboid lip was dissected, with no complications observed. CONCLUSIONS: Morphological classification of the rhomboid lip and understanding of its anatomical details contribute to safe surgical field development for neurosurgeons.

A Case Report of Idiopathic Intracranial Hypertension With Left-Sided Facial Spasm.

Idiopathic intracranial hypertension (IIH) typically presents with increased intracranial pressure of an unknown origin. Facial spasms are an uncommon manifestation of IIH. We report a 56-year-old female patient displaying atypical IIH symptoms of left-sided facial spasm. Clinical examination and imaging confirmed the diagnosis of IIH, and the patient received treatment with acetazolamide. This case highlights the importance of considering IIH as a potential diagnosis in patients with facial spasms, especially when accompanied by other neurological symptoms. Early recognition, a high level of suspicion, and appropriate management are crucial for optimizing outcomes in IIH cases. Furthermore, collaboration among neurologists, neurosurgeons, radiologists, and ophthalmologists is essential for the comprehensive evaluation and management of IIH patients.

Impact of Botulinum Toxin Injections on Quality of Life of Patients with Long-Standing Peripheral Facial Palsy.

(1) Background: Sequels of facial palsy lead to major psychosocial repercussions, disrupting patients' quality of life (QoL). Botulinum toxin (BoNT) injections can permit us to treat long-standing facial palsy, improving facial symmetry and functional signs including synkinesis and contractures. (2) Methods: The main aim of this study was to assess the evolution of the QoL for patients with long-standing facial palsy before, at 1 month, and at 4 months after BoNT injections by using three questionnaires (HFS-30, FaCE, and HAD). The other goals were to find clinical factors associated with the improvement in the QoL and to assess the HFS-30 questionnaire for patients with unilateral facial palsy (3) Results: Eighty-eight patients were included in this study. There was a statistically significant improvement in QoL at 1 month after injections, assessed using the three questionnaires. This improvement was sustained at 4 months after the injections, with a statistically significant difference for the HFS-30 and FaCE questionnaires. (4) Conclusions: This study showed that the BoNT injections lead to a significant increase in the QoL of patients with unilateral facial palsy. This improvement is sustained 4 months after the injections.

Botulinum Toxin Injections to Manage Sequelae of Peripheral Facial Palsy.

Long-standing facial palsy sequelae cause functional, aesthetic, and psychological problems in patients. Botulinum toxin is an effective way to manage them, but no standardized recommendations exist. Through this non-systematic review, we aimed to guide any practitioner willing to master the ins and outs of this activity. We reviewed the existing literature and completed, with our experience as a reference center, different strategies of botulinum toxin injections used in facial palsy patients, including history, physiopathology, facial analysis, dosages, injection sites, and techniques, as well as time intervals between injections. The reader will find all the theorical information needed to best guide injections according to the patient's complaint, which is the most important information to consider.

Intraoperative Brainstem Auditory Evoked Potentials and Postoperative Nausea and Vomiting After Microvascular Decompression.

BACKGROUND: We performed this study to investigate the effect of intraoperative brainstem auditory evoked potential (IBAEP) changes on the development of postoperative nausea and vomiting (PONV) after microvascular decompression (MVD) for neurovascular cross compression. METHODS: A total of 373 consecutive cases were treated with MVD. The use of rescue antiemetics after surgery was used as an objective indicator of PONV. IBAEP monitoring was routinely performed in all. RESULTS: The use of rescue antiemetics was significantly associated with female sex (OR = 3.427; 95% CI, 2.077-5.654; P < 0.001), PCA use (OR = 3.333; 95% CI, 1.861-5.104; P < 0.001), and operation time (OR = 1.017; 95% CI, 1.008-1.026; P < 0.001). A Wave V peak delay of more than 1.0 milliseconds showed a significant relation with the use of rescue antiemetics (OR = 1.787; 95% CI, 1.114-2.867; P = 0.016) and a strong significant relation with the use of rescue antiemetics more than 5 times (OR = 2.426; 95% CI, 1.372-4.290; P = 0.002). CONCLUSIONS: A wave V peak delay of more than 1.0 milliseconds might have value as a predictor of PONV after MVD. More detailed neurophysiological studies will identify the exact pathophysiology underlying PONV after MVD.

Fully endoscopic microvascular decompression for hemifacial spasm: a clinical study and analysis.

Fully endoscopic microvascular decompression (MVD) of the facial nerve is the main surgical treatment for hemifacial spasm. However, the technique presents distinct surgical challenges. We retrospectively analyzed prior cases to consolidate surgical insights and assess clinical outcomes. Clinical data from 16 patients with facial nerve spasms treated at the Department of Neurosurgery in the First Affiliated Hospital of Bengbu Medical College, between August 2020 and July 2023, were retrospectively examined. Preoperatively, all patients underwent magnetic resonance angiography to detect any offending blood vessels; ascertain the relationship between offending vessels, facial nerves, and the brainstem; and detect any cerebellopontine angle lesions. Surgery involved endoscopic MVD of the facial nerve using a mini Sigmoid sinus posterior approach. Various operative nuances were summarized and analyzed, and clinical efficacy, including postoperative complications and the extent of relief from facial paralysis, was evaluated. Fully endoscopic MVD was completed in all patients, with the offending vessels identified and adequately padded during surgery. The offending vessels were anterior inferior cerebellar artery in 12 cases (75%), vertebral artery in 3 cases (18.75%), and posterior inferior cerebellar artery in 1 case (6.25%). Intraoperative electrophysiological monitoring revealed that the lateral spread response of the facial nerve vanished in 15 cases and remained unchanged in 1 case. Postoperative facial spasms were promptly alleviated in 15 cases (93.75%) and delayed in 1 case (6.25%). Two cases of postoperative complications were recorded-one intracranial infection and one case of tinnitus-both were resolved or mitigated with treatment. All patients were subject to follow-up, with no instances of recurrence or mortality. Fully endoscopic MVD of the facial nerve is safe and effective. Proficiency in endoscopy and surgical skills are vital for performing this procedure.

Efficacy of Electroacupuncture with Sparse-Dense-Wave on Patients Suffered Acute Facial Paralysis.

Objective: To explore the efficacy of electroacupuncture (EA) with sparse-dense wave form on the improvement of facial nerve edema, facial spasm, and repair of nerve injury in patients with acute facial paralysis. Methods: This study enrolled 100 patients who were treated for acute facial paralysis in People's Hospital of Dongxihu District from December 2019 to December 2020. They were randomly divided into the control group (continuous wave) and the sparse-dense wave group (sparse-dense wave), following by being intervened by EA with different wave forms. Then the facial disability index (FDI) score, serum levels of immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM) in the two groups were evaluated. Results: The total effectiveness rate (98.00% and 86.00%, respectively; P < 0.05) and the recovery rate of facial spasm (76.00% and 56.00%, respectively; P<0.05) in the sparse-dense wave group was both significantly higher than that of the control group. After treatment, the scores of physical functions of patients in both groups increased (P < 0.05), the scores of social/well-being dysfunctions decreased (P < 0.05). Besides, the levels of serum IgA, IgG, and IgM in both groups decreased (P < 0.05), and the serum levels in the sparse-dense wave group were significantly lower than the control group (P < 0.05). Conclusion: EA intervention with sparse-dense wave form is effective for patients with acute facial paralysis, in that it effectively reduced the occurrence of facial spasm and promoted the improvement of edema and repair of nerve injury.

Facial Spasm Caused by Compression of the Distal Portion of the Facial Nerve by the Anterior Inferior Cerebellar Artery, Resulting in Delayed Peripheral Facial Nerve Palsy: A Case Report.

Delayed onset of facial spasm following surgery for unilateral facial spasm after microvascular decompression (MVD) of the distal facial nerve is rare. We report a case of unilateral facial spasm caused by compression of the distal facial nerve successfully treated with MVD resulting in delayed peripheral facial nerve palsy. A 51-year-old male patient with a left facial spasm showed a gradual worsening of symptoms. Head imaging revealed that the left anterior inferior cerebellar artery (AICA) was in contact with the distal portion of the left facial nerve; hence, MVD was performed. The AICA was pressing on the distal facial nerve, so the AICA was transpositioned. Postoperatively, the facial spasm improved. On the eighth postoperative day, the patient showed left peripheral facial nerve palsy and was given conservative treatment. The patient was discharged home on the sixteenth postoperative day. One month after discharge, the facial palsy was in complete remission. Distal facial nerve compression may cause unilateral facial spasms. Although delayed facial nerve palsy may occur, the prognosis is good.

Epidemiology of post-suboccipital craniotomy headache: A multicentre retrospective study.

The detailed epidemiology and mechanism of post-craniotomy headaches are not well understood. This study aimed to establish the actual clinical incidence and causes of post-craniotomy headaches. Suboccipital craniotomy surgeries performed in six institutions within the five-year study period were included. This study included 311 patients (138 males, 173 female; mean age, 59.3 years old). A total of 145 patients (49%) experienced post-craniotomy headaches. Microvascular decompression surgery, craniectomy and facial spasms were significant risk factors for post-craniotomy headaches. In most cases, the post-craniotomy headaches disappeared within one month; however, some patients suffered from long-term headaches. The craniotomy site and the methods of dura and skull closures should be individually determined for each patient. However, to prevent post-craniotomy headaches, craniotomy, instead of craniectomy, may be considered.

Trigeminal Neuralgia and Hemifacial Spasms Due to Vertebrobasilar Dolichoectasia: A Case Report.

Trigeminal neuralgia is a rare condition characterized by brief, recurrent episodes of severe, unilateral, sharp pain limited to the sensory distribution of the trigeminal nerve. Neurovascular compression in the cisternal segment of the trigeminal nerve is considered the most common cause. Here, we present the case of an elderly man who had a two-year history of electric shock-like pain involving the right side of the face and associated facial spasms. The patient had a long-standing history of hypertension, diabetes mellitus, dyslipidemia, and previous coronary artery bypass graft surgery. The patient underwent magnetic resonance imaging, which revealed abnormal dilatation and tortuosity of the vertebral and basilar arteries, which resulted in compression of the facial and trigeminal nerves along with brainstem compression. Such findings were consistent with the diagnosis of vertebrobasilar dolichoectasia. The patient was given medical treatment in the form of carbamazepine, which resulted in satisfactory improvement in his symptoms. Vertebrobasilar dolichoectasia is a rare cause of neurovascular compression of the trigeminal and facial nerves that can lead to trigeminal neuralgia and facial hemispasm. Medical management should be attempted first, particularly in those patients who are not candidates for surgical interventions.

[Thought on diagnosis and treatment with acupuncture and moxibustion for facial spasm based on qijie theory].

In the guidance of qijie (qi street, path of qi ) theory, the thought on diagnosis and treatment with acupuncture and moxibustion for facial spasm is analyzed. Qijie theory is a summary of the horizontal distribution rule of human body and the conclusion of the characteristics of function and indication in a certain area. In terms of spatial location and functional characteristics, facial spasm is related to "head qijie". In treatment with acupuncture and moxibustion, the local acupoints are predominated. Additionally, the distal acupoints are selected based on the characteristics of qijie in pathological condition, "qijie is unblocked even though the obstruction occurs in minor collateral"; and the acupoints for calming the mind are combined based on the relationship between head qijie and the brain function, aiming to regulating the body, qi and spirit. Regarding the techniques of acupuncture and moxibustion, align with the spatial location and hierarchical location of disease, the depth of filiform needle insertion and needling stimulation are specified and the palpation on the local meridians and acupoints are emphasized before acupuncture specially.

A pacemaker-assisted microvascular decompression for a patient with left primary facial spasm and arrhythmia: a case report.

BACKGROUND: Primary facial spasm accompanied by arrhythmia is a rare clinical phenomenon and has not been reported before. We describe this phenomenon and discuss its mechanism and treatment. CASE PRESENTATION: We herein present a rare case of a patient with left primary facial spasm and a third-degree atrioventricular block (III degree AVB), who was implanted with a temporary cardiac pacemaker to receive microvascular decompression (MVD) because of refusal of a permanent cardiac pacemaker. The symptoms of facial spasm disappeared after MVD. The temporary cardiac pacemaker was removed on the second day after surgery. Her ECG still showed the third-degree atrioventricular block after a follow-up period of 5 months. CONCLUSIONS: We are the first to report a patient with facial spasm and arrhythmia who was implanted with a temporary cardiac pacemaker to receive MVD. This case report demonstrated that the concomitant presence of a III degree AVB maybe not a contraindication for MVD, and the etiology of this facial spasm was the actual vascular compression of the facial nerve entry zone that was not related to the atrioventricular block.

Use of Botulinum Toxin in Orofacial Clinical Practice.

INTRODUCTION: Botulinum neurotoxin (BoNT) is a potent biological toxin and powerful therapeutic tool for a growing number of clinical orofacial applications. BoNT relaxes striated muscle by inhibiting acetylcholine's release from presynaptic nerve terminals, blocking the neuromuscular junction. It also has an antinociceptive effect on sensory nerve endings, where BoNT and acetylcholine are transported axonally to the central nervous system. In dentistry, controlled clinical trials have demonstrated BoNT's efficiency in pathologies such as bruxism, facial paralysis, temporomandibular joint (TMJ) disorders, neuropathic pain, sialorrhea, dystonia and more. AIM: This study's aim was to conduct a systematic literature review to assess the most recent high-level clinical evidence for BoNT's efficacy and for various protocols (the toxin used, dilution, dosage and infiltration sites) used in several orofacial pathologies. MATERIALS AND METHODS: We systematically searched the MedLine database for research papers published from 2014 to 2019 with randomly allocated studies on humans. The search included the following pathologies: bruxism, dislocation of the TMJ, orofacial dystonia, myofascial pain, salivary gland disease, orofacial spasm, facial paralysis, sialorrhea, Frey syndrome and trigeminal neuralgia. RESULTS: We found 228 articles, of which only 20 met the inclusion criteria: bruxism (four articles), orofacial dystonia (two articles), myofascial pain (one article), salivary gland disease (one article), orofacial spasm (two articles), facial paralysis (three articles), sialorrhea (four articles) or trigeminal neuralgia (three articles). DISCUSSION: The clinical trials assessed showed variations in the dosage, application sites and musculature treated. Thus, applying BoNT can reduce symptoms related to motor muscular activity in the studied pathologies efficiently enough to satisfy patients. We did not identify the onset of any important side effects in the literature reviewed. We conclude that treatment with BoNT seems a safe and effective treatment for the reviewed pathologies.

Structural and Functional Amygdala Abnormalities in Hemifacial Spasm.

Background and Purpose: Hemifacial spasm (HFS) is a rare neuromuscular disorder characterized by unilateral, involuntary, and paroxysmal contractions of orofacial muscles. To elucidate the central neural mechanisms of HFS, we investigated brain gray matter and resting-state functional connectivity (rsFC) in HFS patients. Methods: Thirty patients with HFS and 30 age- and sex-matched healthy participants consented to the study. T1-weighted structural magnetic resonance imaging (MRI) and resting-state BOLD images were collected in all participants. Cortical gray matter thickness was assessed, and subcortical volumetric analysis was performed. Seed-based rsFC analysis was performed on structurally abnormal regions in HFS patients. Post hoc correlations with HFS severity and measures of mood (i.e., depression and anxiety) were performed to characterize rsFC alterations. Results: There were no significant differences in cortical thickness in HFS patients compared to healthy controls. Patients with HFS presented smaller right amygdala volume in contrast to healthy controls (q < 0.05, false-discovery rate corrected). We found that the right amygdala had increased rsFC with bilateral medial prefrontal cortex (mPFC), bilateral orbital frontal cortex (OFC), and left posterior insula (L postIns; voxel-wise p < 0.05, family-wise error corrected). Moreover, the connections of amygdala-postIns and amygdala-mPFC were positively related to HFS severity and anxiety, respectively. Conclusions: This is the first study to show structural and functional brain abnormalities in HFS. The volumetric and rsFC amygdala abnormalities were potentially driven by HFS, providing novel insights into HFS pathophysiology.

Radiosurgery for Epidermoid Tumors: Dramatic Pain Relief from Trigeminal Neuralgia.

Purpose  The purpose of this study is to discuss the long-term effects of radiosurgery for epidermoid tumors, including the symptoms of trigeminal neuralgia and/or facial spasm, which we have originally reported before. Background Intracranial epidermoids are slow-growing tumors that can become symptomatic once they develop into large tumors. The mainstay of the treatment is surgery. However, eradicating the whole tumor is often difficult and some tumors may recur. In addition to their mass effects on the brain, these tumors are often associated with hyperactive nerve dysfunction syndromes such as trigeminal neuralgia, glossopharyngeal neuralgia, and/or facial spasm. Cases and methods  We report 13 cases of epidermoid tumors, 12 of which were located in the cerebellopontine angle (CPA), which were treated using 14 radiosurgery procedures. The inclusion criteria for radiosurgery were the presence of well-localized small tumors and/or severe associated neuralgia or facial spasms. The mean target volume ranged from 0.17 to 9.5 cm3 with a mean of 2.85 cm3. The lesions were treated with a mean maximum and a marginal dose of 28.2 Gy and 14.2 Gy, respectively. Results Among the 14 gamma knife procedures that were performed in 13 patients, dose planning to ensure total and partial coverage for relief from hyperactive cranial nerve dysfunction (HCND) was performed. Six cases were totally and another eight were partially covered at the dose planning. The irradiated tumors showed a minor decrease or no remarkable changes during a mean follow-up period of 86.1 months. Tumor progression requiring a second surgery was seen in two cases. The trigeminal neuralgias either improved or disappeared soon after the procedure, enabling the discontinuation of the medication. Conclusion  Radiosurgery led to a dramatic improvement in HCND. In fact, the immediate cure of neuralgia after the radiosurgery was observed in several cases, even after partial coverage with radiosurgery. The interface between the tumor and the nerve was the main target. The definite mechanisms for this favorable outcome have not been verified yet, but the functional modulation by the radiosurgery could be one. Electrophysiological alteration at the interface between the tumor and nerve has been considered. When the tumors were totally covered with radiosurgery, persistent tumor control was expected. Sufficient tumor control is possible if the tumor can be covered entirely with radiosurgery. Functional modulation of trigeminal neuralgia and facial spasms can also be attained even by partial dose planning for the nerve-tumor interface.

Bilateral Facial Spasm Following Guillain-Barré Syndrome.

Background: We report a patient who developed lower facial muscle spasm at rest and bilateral facial synkinesis several months after treatment of Guillain-Barré syndrome (GBS); this finding, to our knowledge, is hitherto unreported. Phenomenology Shown: Bilateral synkinesis, facial muscles spasm at rest, bilateral postparalytic facial syndrome. Educational Value: Aberrant regeneration of nerve fibers post GBS, resulting in facial muscles spasm at rest, bilateral synkinesis.

[Comparative observation of the efficacy on facial spasm among different therapies].

OBJECTIVE: To compare the differences in the clinical efficacy on facial spasm among auricular acupuncture, acupuncture and western medication. METHODS: Ninety cases of facial spasm were randomized into an auricular acupuncture group, an acupuncture group and a western medication group, 30 cases in each one. In the auricular acupuncture group, yan (LO5), shenmen (TF4), xin (CO15), gan (CO12), pi (CO13), pizhixia (AT4), chuiqian (LO4), and zhen (AT3) were selected. In the acupuncture group, Baihui (GV 20), Fengchi (GB 20), Sibai (ST 2), Xiaguan (ST 7), Chengqi (ST 1), Hegu (LI 4), Taichong (LR 3) and Zusanli (ST 36) were selected. The needling therapy was given once a day in these two groups and 5 treatments as one session. There were 2 days at intervals. Totally two sessions were required. In the western medication group, carbamazepine tablets were prescribed for oral administration, 0.1 g each time, three times a day, for 7 days as one session, and totally 2 sessions were required. The facial spasmodic intensity was observed before and after treatment in the three groups. The effects were compared among the three groups. RESULTS: After treatment, the facial spasmodic intensity was reduced as compared with that before treatment in all of the three groups (all P<0.05). The result in the auricular acupuncture group was better than the other two groups (both P<0.05). The result in the acupuncture group was better than that in the western medication group (P<0.05). The total effective rates were 93.3% (28/30), 80.0% (24/30) and 53.3% (16/30) in the three groups separately. The efficacy in the auricular acupuncture group was better than either the acupuncture group or the western medication group (both P<0.05). The result in the acupuncture group was better than that in the western medication group (P<0.05). The efficacy in the cases with the diseases duration less than 6 months was significantly better than that in the cases with the diseases duration over 6 months (all P<0.05). What's more, the efficacy of the auricular acupuncture group were the best. CONCLUSIONS: The auricular acupuncture is quite optimal in the treatment of facial spasm. Its efficacy is better than that of routine acupuncture and carbamazepine. The efficacy is especially better in the cases with the diseases duration less than 6 months.

Treatment of hemifacial spasm in patient with hemifacial atrophy using combination therapy (ultrasound therapy and TENS): a case report.

A 19-year-old male patient presented with facial hemi-atrophy with unilateral spasms of the masseter and temporalis muscles. Ultrasound therapy and Transcutaneous Electric Nerve Stimulation therapy, known as combination therapy, were given on alternate days for 2 weeks. At the end of 2 weeks of combination therapy the patient reported a drastic reduction in the number of episodes of muscle spasm. The visual analog scale score for tenderness of the masseter and temporalis was also markedly reduced. No one has previously used combination therapy for the treatment of facial hemi-atrophy with hemi-facial spasms. The encouraging results of the combination therapy has prompted us to document this study.