gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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Use of high resolution MRI in patients with hemifacial spasm – correlation with intraoperative findings

Hoch-auflösende MRT bei Patienten mit Hemispasmus facialis - Korrelation mit intraoperativen Befunden

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  • corresponding author D. Rasche - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • M. Kloß - Neurologische Klinik, Universitätsklinikum Heidelberg
  • M. Krause - Neurologische Klinik, Universitätsklinikum Heidelberg
  • C. Schwark - Neurologische Klinik, Universitätsklinikum Heidelberg
  • A. Unterberg - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • V. M. Tronnier - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • B. Kress - Abteilung Neuroradiologie, Universitätsklinikum Heidelberg

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc11.05.-10.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2005/05dgnc0222.shtml

Published: May 4, 2005

© 2005 Rasche et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

The pathophysiological cause of hemifacial spasm (HFS) is not known. A neurovascular compression theory of the nerve in the pontomesencephalic cistern is currently under discussion, but usually operative decompression is not generally offered to the patients. The aim of this prospective study was to correlate the results of high resolution MRI sequences of the facial nerves with intraoperative findings.

Methods

In 25 patients with HFS high resolution MRI of the pontomesencephalic cistern was performed using a T2-TrueFisp sequence with a slice thickness of 0.3 mm to create a 3D-volume. Also a T1-Flash-3D-vibe sequence (+/- gadolinium) with 0.9 mm slice thickness was acquired. A total number of 15 patients were operated using the classical suboccipital approach and microvascular decompression with insertion of a Gore-Tex cushion was achieved.

Results

A neurovascular conflict was suggested by MRI in 22/25 (88%) patients with HFS. In three cases a neurovascular contact of the non-affected facial nerve was demonstrated. Intraoperatively in all cases an arterial compression of the facial nerve was found and decompression of the nerve root entry zone could be achieved. In 8 cases the anterior inferior cerebellar artery, in 5 cases the posterior inferior cerebellar artery, in one case each the vertebral or a megadolichobasilar artery were the compressing vessels. These cases were positive correlated with the preoperative MRI findings.

Conclusions

Modern high resolution imaging of the parapontine angle can visualise neurovascular conflicts in patients with HFS. In these cases operative treatment should be offered as an alternative to local botulinum toxin injections.