Clinical Analysis of Patients with Ipsilateral Coexistence of Hemifacial Spasm and Trigeminal Neuralgia

Abstract

Objective: We sought to analyze the clinical data of patients with ipsilateral coexistence of hemifacial spasm (HFS) and trigeminal neuralgia (TN) and their treatment by microvascular decompression.

Methods: We retrospectively analyzed the clinical data, imaging examination, offending vessels, surgical methods, and efficacy in 40 patients with ipsilateral coexistence of HFS and TN from January 2009 to January 2018. The posterior cranial fossa was measured using ITK-SNAP 3.0, which counted the cerebrospinal fluid volume on the basis of the region of interest. Preoperative and postoperative status was based on visual analog scale pain scores and Cohen evaluation scale.

Results: Preoperative visual analog scale pain scores were 10 for 30 patients, 9 for 8 patients, and 8 for 2 patients. Preoperative Cohen scores were 4 and 3 for 14 and 26 patients, respectively. A big looped vertebral basilar artery (VBA) was identified in the operative field in 18 patients (45%), which was regarded as the direct offending vessel. Postoperative the Barrow Neurological Institute scores were excellent (T = 2) for 30 patients (75%). The HFS completely disappeared in 28 patients (70%). In the follow-up period (12-110 months), no recurrence or any dysfunction of cranial nerves was found. When patients were grouped as per the responsible artery, the mean size of the posterior cranial fossa was significantly lower in the patients with VBA involved, compared with the patients in the noninvolved VBA group. In the VBA-involved group, HFS symptoms first appeared in all 18 patients, while in the non-VBA-involved group, HFS symptoms first appeared in 6/22 patients (P < 0.05). The preoperative Cohen score of the 4 patients in the VBA involved group, as well as that of 22 patients in the non-VBA-involved group, was 3 (P < 0.05).

Conclusions: Our study suggests that patients with ipsilateral coexistence of HFS and TN usually have a narrower and smaller posterior fossa and have a large looped VBA as the responsible artery. In addition, patients with VBA involvement often develop HFS symptoms first and are more severe than those with non-vertebral artery involvement. Microvascular decompression is effective for patients with ipsilateral coexistence of HFS and TN.

Keywords: Hemifacial spasm; Posterior cranial fossa; Surgical outcome; Trigeminal neuralgia; Vertebral artery.