Classification of neurovascular compression in typical hemifacial spasm: three-dimensional visualization of the facial and the vestibulocochlear nerves

Ramin Naraghi Priv. Doz. Dr. med. 1 , Levent Tanrikulu Dr. med. 1 , Regina Troescher-Weber Dr. med. 2 , Barbara Bischoff Dr. med. 1 , Martin Hecht Priv. Doz. Dr. med. 3 , Michael Buchfelder Prof. Dr. med. 1 and Peter Hastreiter Priv. Doz. Dr.-Ing. 1
View More View Less
  • 1 Departments of Neurosurgery and
  • 3 Neurology, and
  • 2 Division of Neuroradiology, Department of Diagnostic Radiology, Friedrich-Alexander-University of Erlangen–Nuremberg, Erlangen, Germany
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

In this paper, the authors introduce a method of noninvasive anatomical analysis of the facial nerve–vestibulocochlear nerve complex and the depiction of the variable vascular relationships by using 3D volume visualization. With this technique, a detailed spatial representation of the facial and vestibulocochlear nerves was obtained. Patients with hemifacial spasm (HFS) resulting from neurovascular compression (NVC) were examined.

Methods

A total of 25 patients (13 males and 12 females) with HFS underwent 3D visualization using magnetic resonance (MR) imaging with 3D constructive interference in a steady state (CISS). Each data set was segmented and visualized with respect to the individual neurovascular relationships by direct volume rendering. Segmentation and visualization of the facial and vestibulocochlear nerves were performed with reference to their root exit zone (REZ), as well as proximal and distal segments including corresponding blood vessels. The 3D visualizations were interactively compared with the intraoperative situation during microvascular decompression (MVD) to verify the results with the observed microneurosurgical anatomy.

Results

Of the 25 patients, 20 underwent MVD (80%). Microvascular details were recorded on the affected and unaffected sides. On the affected sides, the anterior inferior cerebellar artery (AICA) was the most common causative vessel. The posterior inferior cerebellar artery, vertebral artery, internal auditory artery, and veins at the REZ of the facial nerve (the seventh cranial nerve) were also found to cause vascular contacts to the REZ of the facial nerve. In addition to this, the authors identified three distinct types of NVC within the REZ of the facial nerve at the affected sides. The authors analyzed the varying courses of the vessels on the unaffected sides. There were no bilateral clinical symptoms of HFS and no bilateral vascular compression of the REZ of the facial nerve. The authors discovered that the AICA is the most common vessel that interferes with the proximal and distal portions of the facial nerve without any contact between vessels and the REZ of the facial nerve on the unaffected sides.

Conclusions

Three-dimensional visualization by direct volume rendering of 3D CISS MR imaging data offers the opportunity of noninvasive exploration and anatomical categorization of the facial nerve–vestibulocochlear nerve complex. Furthermore, it proves to be advantageous in establishing the diagnosis and guiding neurosurgical procedures by representing original MR imaging patient data in a 3D fashion. This modality provides an excellent overview of the entire neurovascular relationship of the cerebellopontine angle in each case.

Abbreviations used in this paper:AICA = anterior inferior cerebellar artery; BA = basilar artery; CISS = constructive interference in steady state; CPA = cerebellopontine angle; CSF = cerebrospinal fluid; DVR = direct volume rendering; HFS = hemifacial spasm; IAA = internal auditory artery; IAC = internal auditory canal; MR = magnetic resonance; MVD = microvascular decompression; NVC = neurovascular compression; PICA = posterior inferior cerebellar artery; REZ = root exit zone; SR = surface rendering; VA = vertebral artery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Ramin Naraghi, Priv. Doz. Dr. med., Department of Neurosurgery, University of Erlangen–Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany. email: naraghi@nch.imed.uni-erlangen.de.
  • 1

    Akimoto H, , Nagaoka T, , Nariai T, , Takada Y, , Ohno K, & Yoshino N: Preoperative evaluation of neurovascular compression in patients with trigeminal neuralgia by use of three-dimensional reconstruction from two types of high-resolution magnetic resonance imaging. Neurosurgery 51:956962, 2002

    • Search Google Scholar
    • Export Citation
  • 2

    Ballantyne ES, , Page RD, , Meaney JF, , Nixon TE, & Miles JB: Coexistent trigeminal neuralgia, hemifacial spasm, and hypertension: preoperative imaging of neurovascular compression. Case report. J Neurosurg 80:559563, 1994

    • Search Google Scholar
    • Export Citation
  • 3

    Barker FG II, , Jannetta PJ, , Bissonette DJ, , Shields PT, , Larkins MV, & Jho HD: Microvascular decompression for hemifacial spasm. J Neurosurg 82:201210, 1995

    • Search Google Scholar
    • Export Citation
  • 4

    Defazio G, , Abbruzzese G, , Girlanda P, , Vacca L, , Curra A, & De Salvia R, : Botulinum toxin A treatment for primary hemifacial spasm: a 10-year multicenter study. Arch Neurol 59:418420, 2002

    • Search Google Scholar
    • Export Citation
  • 5

    Deimling M, & Laub G: Constructive interference in steady state for motion sensitivity reduction. Society of Magnetic Resonance in Medicine: Book of Abstracts Berkeley, Society of Magnetic Resonance in Medicine, 1989. 842

    • Search Google Scholar
    • Export Citation
  • 6

    Fukuda H, , Ishikawa M, & Okumura R: Demonstration of neurovascular compression in trigeminal neuralgia and hemifacial spasm with magnetic resonance imaging. Comparison with surgical findings in 60 consecutive cases. Surg Neurol 59:93100, 2003

    • Search Google Scholar
    • Export Citation
  • 7

    Girard N, , Poncet M, , Caces F, , Tallon Y, , Chays A, & Martin-Bouyer P, : Three-dimensional MRI of hemifacial spasm with surgical correlation. Neuroradiology 39:4651, 1997

    • Search Google Scholar
    • Export Citation
  • 8

    Haines SJ, & Torres F: Intraoperative monitoring of the facial nerve during decompressive surgery for hemifacial spasm. J Neurosurg 74:254257, 1991

    • Search Google Scholar
    • Export Citation
  • 9

    Hamlyn P: Neurovascular Compression of Lower Cranial Nerves Amsterdam, Elsevier, 1999

  • 10

    Hastreiter P, , Naraghi R, , Tomandl B, , Bonk A, & Fahlbusch R: Analysis and 3-dimensional visualization of neurovascular compression syndromes. Acad Radiol 10:13691379, 2003

    • Search Google Scholar
    • Export Citation
  • 11

    Hitotsumatsu T, , Matsushima T, & Inoue T: Microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia: three surgical approach variations: technical note. Neurosurgery 53:14361441, 2003

    • Search Google Scholar
    • Export Citation
  • 12

    Huang CI, , Chen IH, & Lee LS: Microvascular decompression for hemifacial spasm. Neurosurgery 30:5356, 1992

  • 13

    Jannetta PJ, Hemifacial spasm. Samii M, & Jannetta PJ: The Cranial Nerves Berlin, Springer Verlag, 1981. 484493

  • 14

    Jannetta PJ, , Abbasy M, , Maroon JC, , Ramos FM, & Albin MS: Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg 47:321328, 1977

    • Search Google Scholar
    • Export Citation
  • 15

    Jitpimolmard S, , Tiamkao S, & Laopaiboon M: Long term results of botulinum toxin type A (Dysport) in the treatment of hemifacial spasm: a report of 175 cases. J Neurol Neurosurg Psychiatry 64:751757, 1998

    • Search Google Scholar
    • Export Citation
  • 16

    Kakizawa Y, , Hongo K, , Takasawa H, , Miyairi Y, , Sato A, & Tanaka Y, : “Real” three-dimensional constructive interference in steady-state imaging to discern microneurosurgical anatomy. Technical note. J Neurosurg 98:625630, 2003

    • Search Google Scholar
    • Export Citation
  • 17

    Kumon Y, , Sakaki S, , Kohno K, , Ohta S, , Ohue S, & Miki H: Three-dimensional imaging for presentation of the causative vessels in patients with hemifacial spasm and trigeminal neuralgia. Surg Neurol 47:178184, 1997

    • Search Google Scholar
    • Export Citation
  • 18

    Kureshi SA, & Wilkins RH: Posterior fossa reexploration for persistent or recurrent trigeminal neuralgia or hemifacial spasm: surgical findings and therapeutic implications. Neurosurgery 43:11111117, 1998

    • Search Google Scholar
    • Export Citation
  • 19

    Lang J: Clinical Anatomy of the Posterior Cranial Fossa and Its Foramina New York, Thieme, 1991

  • 20

    Lovely TJ, , Getch CC, & Jannetta PJ: Delayed facial weakness after microvascular decompression of cranial nerve VII. Surg Neurol 50:449452, 1998

    • Search Google Scholar
    • Export Citation
  • 21

    McLaughlin MR, , Jannetta PJ, , Clyde BL, , Subach BR, , Comey CH, & Resnick DK: Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90:18, 1990

    • Search Google Scholar
    • Export Citation
  • 22

    Mitsuoka H, , Arai H, , Tsunoda A, , Okuda O, , Sato K, & Makita J: Microanatomy of the cerebellopontine angle and internal auditory canal: study with new magnetic resonance imaging technique using three-dimensional fast spin echo. Neurosurgery 44:561567, 1999

    • Search Google Scholar
    • Export Citation
  • 23

    Nagahiro S, , Takada A, , Matsukado Y, & Ushio Y: Microvascular decompression for hemifacial spasm. Patterns of vascular compression in unsuccessfully operated patients. J Neurosurg 75:388392, 1991

    • Search Google Scholar
    • Export Citation
  • 24

    Naraghi R, , Hastreiter P, , Tomandl B, , Bonk A, , Huk W, & Fahlbusch R: Three-dimensional visualization of neurovascular relationships in the posterior fossa: technique and clinical application. J Neurosurg 100:10251035, 2004

    • Search Google Scholar
    • Export Citation
  • 25

    Ogiwara M, & Shimizu T: Surface rendered three-dimensional MR imaging for the evaluation of trigeminal neuralgia and hemifacial spasm. J Clin Neurosci 11:840844, 2004

    • Search Google Scholar
    • Export Citation
  • 26

    Payner TD, & Tew JM Jr: Recurrence of hemifacial spasm after microvascular decompression. Neurosurgery 38:686691, 1996

  • 27

    Rhoton AL Jr: The cerebellopontine angle and posterior fossa cranial nerves by the retrosigmoid approach. Neurosurgery 47:3 Suppl 93129, 2000

    • Search Google Scholar
    • Export Citation
  • 28

    Samii M, , Gunther T, , Iaconetta G, , Muehling M, , Vorkapic P, & Samii A: Microvascular decompression to treat hemifacial spasm: long-term results for a consecutive series of 143 patients. Neurosurgery 50:712719, 2002

    • Search Google Scholar
    • Export Citation
  • 29

    Tomandl BF, , Hastreiter P, , Rezk-Salama C, , Engel K, , Ertl T, & Huk WJ, : Local and remote visualization techniques for interactive direct volume rendering in neuroradiology. Radiographics 21:15611572, 2001

    • Search Google Scholar
    • Export Citation
  • 30

    Wang A, & Jankovic J: Hemifacial spasm: clinical findings and treatment. Muscle Nerve 21:17401747, 1998

Metrics

All Time Past Year Past 30 Days
Abstract Views 771 390 40
Full Text Views 276 39 0
PDF Downloads 172 23 2
EPUB Downloads 0 0 0