© Georg Thieme Verlag KG Stuttgart · New York
Treatment of Idiopathic Hemifacial Spasm with Radiosurgery or Hypofractionated Stereotactic Radiotherapy: Preliminary Results
07. April 2010 (online)
Introduction: Microvascular decompression in the posterior cranial fossa is the first treatment option for hemifacial spasm. For patients not suitable for surgery because of advanced age, poor general conditions or patients who refuse surgery, radiotherapeutic treatment could be an alternative. Only one case of resolution of hemifacial spasm in a patient undergoing radiosurgery for an intracanalicular vestibular schwannoma has been described in the literature. In this article we present three patients affected by idiopathic hemifacial spasm, refractory to medical therapy and botulinum toxin injections, who were treated by radiosurgery in one case and hypofractionated stereotactic radiotherapy in the other two.
Methods: Radiosurgery, with a single dose of 8 Gy, was used in the first patient affected by idiopathic hemifacial spasm and autoimmune polyneuropathy with severe hypoacusia; hypofractionated stereotactic radiotherapy, with 15 Gy in 5 fractions of 3 Gy each, was preferred in the other 2 cases. In all patients, the target consisted of the vestibulocochlear-facial bundle immediately before its entry into the internal acoustic foramen.
Results: A marked improvement of symptoms was observed in 2 patients, and almost complete disappearance in the other case, with no complications, particularly, auditory.
Conclusion: The mean follow-up time of 24 months reported here could be judged too short, and our series too small, but the good results observed so far lead us to underline that, as in trigeminal neuralgia, radiosurgery or hypofractionated stereotactic radiotherapy could represent a therapeutic alternative to microvascular decompression for idiopathic hemifacial spasm for patients not suitable for surgery.
idiopathic hemifacial spasm - radiosurgery - hypofractionated stereotactic radiotherapy - image fusion
- 1 Kong DS, Park K. Hemifacial spasm: a neurosurgical perspective. J Korean Neurosurg Soc. 2007; 42 355-362
- 2 Engh J A, Horowitz M, Burkhart L. et al . Repeat microvascular decompression for hemifacial spasm. J Neurol Neurosurg Psychiatry. 2005; 76 1574-1580
- 3 Barker FG, Jannetta PJ, Bissonette DJ. et al . Microvascular decompression for hemifacial spasm. J Neurosurg. 1995; 82 201-210
- 4 McLaughlin MR, Jannetta PJ, Clyde BL. et al . Microvascular decompression of cranial nerves: lessons learned after 4 400 operations. J Neurosurg. 1999; 90 1-8
- 5 Fukushima T. Microvascular decompression for hemifacial spasm: results in 2 890 cases.. In: Carter LP, Spetzler RF Neurovascular Surgery. New York: McGraw-Hill; 1995: 1133-1145
- 6 Goto Y, Matsushima T, Natori Y. et al . Delayed effects of the microvascular decompression on hemifacial spasm: a retrospective study of 131 consecutive operated cases. Neurol Res. 2002; 24 296-300
- 7 Samii A. Microvascular decompression to treat hemifacial spasm: long-term results for a consecutive series of 143 patients. Neurosurgery. 2002; 50 712-718
- 8 Sindou MP. Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring. Acta Neurochir (Wien). 2005; 147 1019-1026
- 9 Maesawa S, Salame C, Flickinger JC. et al . Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg. 2001; 94 14-20
- 10 Little AS, Shetter AG, Shetter ME. et al . Long-term pain response and quality of life in patients with typical trigeminal neuralgia treated by gamma knife stereotactic radiosurgery. Neurosurgery. 2008; 63 914-925
- 11 Peker S, Ozduman K, Kiliç T. et al . Relief of hemifacial spasm after radiosurgery for intracanalicular vestibular schwannoma. Minim Invas Neurosurg. 2004; 47 235-237
- 12 Tan EK, Fook-Chong S, Lum SY. et al . Validation of a short disease specific quality of life scale for hemifacial spasm: correlation with SF-36. J Neurol Neurosurg Psychiatry. 2005; 76 1707-1710
- 13 Pollock BE, Foote RL, Link MJ. et al . Repeat radiosurgery for idiopathic trigeminal neuralgia. Int J Oncol Biol Phys. 2005; 61 192-195
- 14 Régis J, Metellus P, Hayashi M. Prospective controlled trial of gamma knife surgery for essential trigeminal neuralgia. J Neurosurg. 2006; 104 913-924
- 15 Sheehan J, Pan HC, Stroila M. Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J Neurosurg. 2005; 102 434-441
- 16 Ferrante L, Artico M, Nardacci B. Glossopharyngeal neuralgia with cardiac sincope. Neurosurgery. 1995; 36 58-63 (Review)
- 17 Fraioli B, Esposito V, Ferrante L. Microsurgical treatment of glossopharyngeal neuralgia: case reports. Neurosurgery. 1989; 25 630-632
M. F. FraioliMD
Department of Neurosciences – Neurosurgery
University of Rome “Tor Vergata”
viale Oxford 81
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