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because of the eye's closing. It is not usually associated with other neurologic deficit nor is it painful. Over a period of years, if not treated, a slight facial weakness will often develop. This must be distinguished from habit spasm or tic. Hemifacial spasm will result in the sudden generalized contraction of the face, but habit spasm involves various muscles and on careful observation will be seen to occur independently. Epilepsy partialis continuum, a rare form of epilepsy, may mimic hemifacial spasm; however, in this form of epilepsy, the facial movements are much more rapid and other muscles are often involved. Blepharospasm, for which there is no good treatment, is limited to closure of the eye alone and does not involve the face. It is often bilateral. It has been appreciated for many years that there may be a pathologic process such as arteriovenous malformation, tumor or aneurysm compressing the facial nerve resulting in hemifacial spasm. Recently, in a large number of cases, Jannetta has demonstrated arterial compression of the seventh cranial nerve, usually by the vertebral artery or the anterior inferior cereoellar artery or the posterior inferior cerebellar artery.-'^ Medical management or treatment is unsatisfactory, although sedatives may temporarily give short periods of improvement in the symptoms. Previous operative procedures have been numerous with none being dependably successful. Most operations have been designed to injure the nerve partially, thereby substituting facial weak- ness for facial hyperactivity. In the older destructive operation, the facial nerve was partially sectioned either in its main trunk between the stylomastoid foramen and the parotid gland or more distally at its ramifications in the face. The posterior fossa neurovascular decompression of the seventh cranial nerve using microsurgical techniques is the definitive treatment for hemifacial spasm at the present time and produces excellent results. Operative Procedure The same approach is used as for decompressing the fifth nerve in the treatment of tic douloureux described previously. The seventh and eighth cranial nerves are exposed in the subarachnoid space. The seventh nerve is found to be compressed by the vertebral, anterior inferior cerebellar artery, or the posterior inferior cerebellar artery as it crosses the subarachnoid space before its entrance into the porus acusticus. The artery is dissected from the nerve and a synthetic sponge is placed between the nerve and the artery. Postoperatively the patient has improvement immediately but will often have occasional spasms which will disappear over three to four weeks. The more the nerve is manipulated at the time of operation, the more rapid the improvement. Some impairment of hearing has been reported by others in 20% of cases.^ We have not as yet experienced this complication. Results Since March, 1976, we have used Y N AICA vn, Ym N Fig. 4. Drawing of the anterior inferior cerebellar artery compressing the seventh cranial nerve before its exit through the internal auditory meatus. Two sponges were inserted. this procedure in two women and three men. In one of the men, the procedure was combined with that for tic douloureux. All five patients have experienced excellent results with complete relief of their hemifacial spasm. 1. Sweet WH. Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. Part 1 Trigeminal neuralgia. J Neurosurg 39:143-156. 1974 2 Jannetta PJ. Arterial compression of the trigeminal nerve in patterns with trigeminal neuralgia. J Neurosurg 26: 159-162, i%7, 3. Jannetta PJ: Personal communication 4. Dandy WE: Trigeminal neuriilgia. Am J Surg 24:447-455, 1934. 5. Jannetta PJ: The cause of hemifacial spasm: definitive microsurgical treatment at the brainstem in 31 patients. Trans Am Acad Ophthalmol Otolaryngol 80:319-322. 1975 6 Neagoy DR. Dohn DF Hemifacial spasm secondary to vascular compression of the facial nerve. Cleve Clin Q 41:205-214. 1974. REVIEWER'S COMMENT: Since most of the patients we see with tic douloureux are elderly, we have produced the stereotactic coagulation lesion of the fifth nerve ganglion instead of using the pos-teriorfossaapproach. However, for younger patients most interested in preserving sensation, the posterior fossa approach is quite reasonable and one we will also practice in the future. in this country, the symptomatic affection of the lungs, in chronic hepatitis and indigestion, has excited much attention, and has been treated of under the names of "hepatic phthisis," "dyspeptic phthisis." and "stomach cough." Where there is evidently derangement of the Hveror stomach, and the patient is lately from a hot climate, the EngHsh practitioner sets down any pulmonary affection that may be complained of. as symptomatic, of course, of the abdominal disorder — and thus, that time is lost in abortive attempts to remove both classes of complaints by strikmg at the original one. which might have saved the lungs from irremediable disorganization. Many are the instances I have seen, and continue to see, where patients have been pronounced to be labouring under symptomatic disease only, while a few minutes' examination of the chest, by percussion and auscultation, detected organic changes in the lungs or heart, which had passed the period when any chance of recovery could be expected. This, in fact, is one of the greatest dangers which the tropical invalid runs, when he embarks for his native climate, where pulmonary complaints are the prevailing diseases. — An Essay on Indigestion; or Morbid Sensibility of the Stomach ct Bowels. James Johnson. 1836. p. 137. 536 Vol. 38. No. 10
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1977 |
Identifier | NCHH-17-038 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 38 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-038.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-038 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 536 (image) |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1977 |
Identifier | NCHH-17-038-0190 |
Form General | Periodicals |
Page Type | all; all images; diagram; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncmed38v21977medi_0190.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 38 |
Issue Number | 9 |
Page Number | 536 |
Health Discipline | Medicine |
Full Text | because of the eye's closing. It is not usually associated with other neurologic deficit nor is it painful. Over a period of years, if not treated, a slight facial weakness will often develop. This must be distinguished from habit spasm or tic. Hemifacial spasm will result in the sudden generalized contraction of the face, but habit spasm involves various muscles and on careful observation will be seen to occur independently. Epilepsy partialis continuum, a rare form of epilepsy, may mimic hemifacial spasm; however, in this form of epilepsy, the facial movements are much more rapid and other muscles are often involved. Blepharospasm, for which there is no good treatment, is limited to closure of the eye alone and does not involve the face. It is often bilateral. It has been appreciated for many years that there may be a pathologic process such as arteriovenous malformation, tumor or aneurysm compressing the facial nerve resulting in hemifacial spasm. Recently, in a large number of cases, Jannetta has demonstrated arterial compression of the seventh cranial nerve, usually by the vertebral artery or the anterior inferior cereoellar artery or the posterior inferior cerebellar artery.-'^ Medical management or treatment is unsatisfactory, although sedatives may temporarily give short periods of improvement in the symptoms. Previous operative procedures have been numerous with none being dependably successful. Most operations have been designed to injure the nerve partially, thereby substituting facial weak- ness for facial hyperactivity. In the older destructive operation, the facial nerve was partially sectioned either in its main trunk between the stylomastoid foramen and the parotid gland or more distally at its ramifications in the face. The posterior fossa neurovascular decompression of the seventh cranial nerve using microsurgical techniques is the definitive treatment for hemifacial spasm at the present time and produces excellent results. Operative Procedure The same approach is used as for decompressing the fifth nerve in the treatment of tic douloureux described previously. The seventh and eighth cranial nerves are exposed in the subarachnoid space. The seventh nerve is found to be compressed by the vertebral, anterior inferior cerebellar artery, or the posterior inferior cerebellar artery as it crosses the subarachnoid space before its entrance into the porus acusticus. The artery is dissected from the nerve and a synthetic sponge is placed between the nerve and the artery. Postoperatively the patient has improvement immediately but will often have occasional spasms which will disappear over three to four weeks. The more the nerve is manipulated at the time of operation, the more rapid the improvement. Some impairment of hearing has been reported by others in 20% of cases.^ We have not as yet experienced this complication. Results Since March, 1976, we have used Y N AICA vn, Ym N Fig. 4. Drawing of the anterior inferior cerebellar artery compressing the seventh cranial nerve before its exit through the internal auditory meatus. Two sponges were inserted. this procedure in two women and three men. In one of the men, the procedure was combined with that for tic douloureux. All five patients have experienced excellent results with complete relief of their hemifacial spasm. 1. Sweet WH. Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. Part 1 Trigeminal neuralgia. J Neurosurg 39:143-156. 1974 2 Jannetta PJ. Arterial compression of the trigeminal nerve in patterns with trigeminal neuralgia. J Neurosurg 26: 159-162, i%7, 3. Jannetta PJ: Personal communication 4. Dandy WE: Trigeminal neuriilgia. Am J Surg 24:447-455, 1934. 5. Jannetta PJ: The cause of hemifacial spasm: definitive microsurgical treatment at the brainstem in 31 patients. Trans Am Acad Ophthalmol Otolaryngol 80:319-322. 1975 6 Neagoy DR. Dohn DF Hemifacial spasm secondary to vascular compression of the facial nerve. Cleve Clin Q 41:205-214. 1974. REVIEWER'S COMMENT: Since most of the patients we see with tic douloureux are elderly, we have produced the stereotactic coagulation lesion of the fifth nerve ganglion instead of using the pos-teriorfossaapproach. However, for younger patients most interested in preserving sensation, the posterior fossa approach is quite reasonable and one we will also practice in the future. in this country, the symptomatic affection of the lungs, in chronic hepatitis and indigestion, has excited much attention, and has been treated of under the names of "hepatic phthisis" "dyspeptic phthisis." and "stomach cough." Where there is evidently derangement of the Hveror stomach, and the patient is lately from a hot climate, the EngHsh practitioner sets down any pulmonary affection that may be complained of. as symptomatic, of course, of the abdominal disorder — and thus, that time is lost in abortive attempts to remove both classes of complaints by strikmg at the original one. which might have saved the lungs from irremediable disorganization. Many are the instances I have seen, and continue to see, where patients have been pronounced to be labouring under symptomatic disease only, while a few minutes' examination of the chest, by percussion and auscultation, detected organic changes in the lungs or heart, which had passed the period when any chance of recovery could be expected. This, in fact, is one of the greatest dangers which the tropical invalid runs, when he embarks for his native climate, where pulmonary complaints are the prevailing diseases. — An Essay on Indigestion; or Morbid Sensibility of the Stomach ct Bowels. James Johnson. 1836. p. 137. 536 Vol. 38. No. 10 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-038.pdf |
Document Sort | all; nchh-17 |
Article Title | Posterior Fossa Neurovascular Decompression For Tic Douloureux And Hemifacial Spasm |
Article Author | David L. Kelly |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-038 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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