J Neurol Surg A Cent Eur Neurosurg 2015; 76(04): 332-336
DOI: 10.1055/s-0035-1547361
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Real-time Monitoring of the Lateral Spread Response Resulting from Serial Decompression for Hemifacial Spasm Caused by a Fusiform Aneurysm

Sung Ho Lee
1   Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
Seok Keun Choi
1   Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
Johnho Kim
1   Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

26 July 2014

30 December 2014

Publication Date:
08 May 2015 (online)


Fusiform aneurysm as a cause of hemifacial spasm (HFS) is an extremely rare condition. A 69-year-old man developed paroxysmal spasm of his left side facial muscles over a period of 5 years. Radiologic images demonstrated a left vertebral artery (VA) fusiform aneurysm compressing the root entry zone of the left facial nerve. The patient underwent serial surgical procedures for the treatment of HFS under intraoperative electromyography monitoring. Lateral spread response (LSR) did not disappear despite 5 minutes of extracranial left VA ligation and remained after cerebrospinal fluid drainage after dura opening. After interposition of the VA through Teflon felt insertion, the LSR finally disappeared. The patient became symptom free immediately after the surgery and continued as such throughout a follow-up period of 1 year. This is the first report involving real-time monitoring of the LSR changes resulting from serial procedures of decompression in an HFS caused by a fusiform aneurysm of the VA.

  • References

  • 1 Barker II FG, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD. Microvascular decompression for hemifacial spasm. J Neurosurg 1995; 82 (2) 201-210
  • 2 Takahara M, Abe H, Ohkawa M , et al. Hemifacial spasm caused by a dissecting aneurysm of the vertebral artery, and resulting in acute exacerbation [in Japanese]. No Shinkei Geka 2013; 41 (3) 241-246
  • 3 Nakagawa I, Takayama K, Kurokawa S , et al. Hemifacial spasm due to contralateral aneurysmal compression of the facial nerve successfully treated with endovascular coil embolization: case report. Neurosurgery 2011; 69 (3) E768-E771 ; discussion E771–E772
  • 4 Choi SK, Rhee BA, Park BJ, Lim YJ. Hemifacial spasm caused by fusiform aneurysm at vertebral artery-posterior inferior cerebellar artery junction. J Korean Neurosurg Soc 2008; 44 (6) 399-400
  • 5 Williams PL e. Subclavian system of arteries. In: Williams PL, , ed. Gray's Anatomy. 38th ed. New York, NY: Churchill Livingstone; 1995: 1529-1534
  • 6 Anson JA, Lawton MT, Spetzler RF. Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 1996; 84 (2) 185-193
  • 7 Yamashita K, Hojo M, Okamoto S, Kim C, Nakatsu S, Mishima H. Possible role of neurointerventional techniques in the diagnosis of hemifacial spasm. AJNR Am J Neuroradiol 1997; 18 (2) 287-290
  • 8 Nakatomi H, Segawa H, Kurata A , et al. Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms : insight on the mechanism of growth. Stroke 2000; 31 (4) 896-900
  • 9 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 1977; 47 (3) 321-328
  • 10 McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK. Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 1999; 90 (1) 1-8
  • 11 Chung SS, Chang JH, Choi JY, Chang JW, Park YG. Microvascular decompression for hemifacial spasm: a long-term follow-up of 1,169 consecutive cases. Stereotact Funct Neurosurg 2001; 77 (1–4) 190-193
  • 12 Han IB, Kim NK, Huh R , et al. The role of genetic factors in the development of hemifacial spasm: preliminary results. Acta Neurochir Suppl (Wien) 2008; 101: 107-110
  • 13 Kim Y, Tanaka A, Kimura M, Yoshinaga S, Tomonaga M. Arteriovenous malformation in the cerebellopontine angle presenting as hemifacial spasm—case report. Neurol Med Chir (Tokyo) 1991; 31 (2) 109-112
  • 14 Nagata S, Matsushima T, Fujii K, Fukui M, Kuromatsu C. Hemifacial spasm due to tumor, aneurysm, or arteriovenous malformation. Surg Neurol 1992; 38 (3) 204-209
  • 15 Nagashima H, Orz Y, Okudera H, Kobayashi S, Ichinose Y. Remission of hemifacial spasm after proximal occlusion of vertebrobasilar dissecting aneurysm with coils: case report. J Clin Neurosci 2001; 8 (1) 43-45
  • 16 Sato K, Ezura M, Takahashi A, Yoshimoto T. Fusiform aneurysm of the vertebral artery presenting hemifacial spasm treated by intravascular embolization: case report. Surg Neurol 2001; 56 (1) 52-55
  • 17 Matsumoto K, Saijo T, Kuyama H, Asari S, Nishimoto A. Hemifacial spasm caused by a spontaneous dissecting aneurysm of the vertebral artery. Case report. J Neurosurg 1991; 74 (4) 650-652
  • 18 Tsuchiya D, Kayama T, Saito S, Sato S. Hemifacial spasm due to a compression of the facial nerve by a fusiform aneurysm of the vertebral artery: case report [in Japanese]. No To Shinkei 2000; 52 (6) 517-521
  • 19 Uchino M, Nomoto J, Ohtsuka T, Kuramitsu T. Fusiform aneurysm of the vertebral artery presenting with hemifacial spasm treated by microvascular decompression. Acta Neurochir (Wien) 2005; 147 (8) 901-903
  • 20 von Eckardstein K, Harper C, Castner M, Link M. The significance of intraoperative electromyographic “lateral spread” in predicting outcome of microvascular decompression for hemifacial spasm. J Neurol Surg B Skull Base 2014; 75 (3) 198-203
  • 21 Thirumala PD, Shah AC, Nikonow TN , et al. Microvascular decompression for hemifacial spasm: evaluating outcome prognosticators including the value of intraoperative lateral spread response monitoring and clinical characteristics in 293 patients. J Clin Neurophysiol 2011; 28 (1) 56-66
  • 22 Neves DO, Lefaucheur JP, de Andrade DC , et al. A reappraisal of the value of lateral spread response monitoring in the treatment of hemifacial spasm by microvascular decompression. J Neurol Neurosurg Psychiatry 2009; 80 (12) 1375-1380
  • 23 Joo WI, Lee KJ, Park HK, Chough CK, Rha HK. Prognostic value of intra-operative lateral spread response monitoring during microvascular decompression in patients with hemifacial spasm. J Clin Neurosci 2008; 15 (12) 1335-1339
  • 24 Kong DS, Park K, Shin BG, Lee JA, Eum DO. Prognostic value of the lateral spread response for intraoperative electromyography monitoring of the facial musculature during microvascular decompression for hemifacial spasm. J Neurosurg 2007; 106 (3) 384-387
  • 25 Murakami H, Kawaguchi T, Fukuda M, Ito Y, Hasegawa H, Tanaka R. Monitoring of the lateral spread response in the endovascular treatment of a hemifacial spasm caused by an unruptured vertebral artery aneurysm. Case report. J Neurosurg 2004; 101 (5) 861-863
  • 26 Niijima KH, Yonekawa Y, Kaku Y. Disappearance of hemifacial spasm following spinal drainage: a case report [in Japanese]. No Shinkei Geka 1990; 18 (6) 577-580
  • 27 Shin JC, Chung UH, Kim YC, Park CI. Prospective study of microvascular decompression in hemifacial spasm. Neurosurgery 1997; 40 (4) 730-734 ; discussion 734–735