Espasmo hemifacial resultados da descompressão microvascular em 53 pacientes

Niemeyer Filho, Paulo; Bezerra, Marcelo; Mufarrej, Gabriel

doi:10.1590/S0004-282X1990000200013

Resumos

Num período de 10 anos, 53 pacientes com espasmo hemifacial foram submetidos a 54 procedimentos de descompressão microvascular da raiz do facial, na fossa posterior. A técnica empregada foi a mesma desenvolvida por Jannetta e o resultado cirúrgico inicial foi considerado excelente em 91% dos casos. O follow-up variou de 60 dias a 7 anos, cora 40 pacientes acompanhados por mais de 2 anos e 16, por mais de 5 anos. Apenas um paciente apresentou reciciva dos espasmos. Não houve óbito e as complicações não foram importantes, sendo, em sua maioria, transitórias e relacionadas à VII e VIII raízes. Em 4 pacientes não encontramos compressão da raiz. Concluimos que, quaisquer sejam as causas do espasmo hemifacial ou mecanismos de ação da cirurgia, os resultados da descompressão microvascular são excelentes, a curto e longo prazo, e superiores aos obtidos pelas demais formas de tratamento clínico ou cirúrgico.

In a ten year period 53 patients with hemifacial spasm were submitted to 54 microvascular decompression procedures in the posterior fossa. The technique was the same developed by Jannetta and the surgical initial results were considered excellent in 91% of the cases. The follow-up ranges from 60 days to 7 years, with 40 patients followed for more than two years and 16 for more than five years. Only one patient presented late recurrence of the spasms. There was no death nor serious complications which were usually transient and related do the seventh and eight nerve. In four patients we found no compression of the nerve root. We concluded that no matter what the causes of hemifacial spasm or the mechanisms of action of the surgery are the results of microvascular decompression are excellent and superior to all other clinical and surgical methods of treatment.

Paulo Niemeyer Filho^I; Marcelo Bezerra^II; Gabriel Mufarrej^III

^IProfessor Titular de Neurocirurgia e Chefe dos Serviços - Trabalho realizado no Instituto de Neurocirurgia da Santa Casa de Misericórdia do Rio de Janeiro - Pontifícia Universidade Católica do Rio de Janeiro (PUC-RJ) - Serviço de Neurocirurgia da Beneficência Portuguesa do Rio de Janeiro

^IIProfessor Assistente de Neurologia da Universidade do Estado do Rio de Janeiro (UERJ) - Trabalho realizado no Instituto de Neurocirurgia da Santa Casa de Misericórdia do Rio de Janeiro - Pontifícia Universidade Católica do Rio de Janeiro (PUC-RJ) - Serviço de Neurocirurgia da Beneficência Portuguesa do Rio de Janeiro

^IIIPós-Graduando em Neurocirurgia, PUC-RJ - Trabalho realizado no Instituto de Neurocirurgia da Santa Casa de Misericórdia do Rio de Janeiro - Pontifícia Universidade Católica do Rio de Janeiro (PUC-RJ) - Serviço de Neurocirurgia da Beneficência Portuguesa do Rio de Janeiro

RESUMO

Num período de 10 anos, 53 pacientes com espasmo hemifacial foram submetidos a 54 procedimentos de descompressão microvascular da raiz do facial, na fossa posterior. A técnica empregada foi a mesma desenvolvida por Jannetta e o resultado cirúrgico inicial foi considerado excelente em 91% dos casos. O follow-up variou de 60 dias a 7 anos, cora 40 pacientes acompanhados por mais de 2 anos e 16, por mais de 5 anos. Apenas um paciente apresentou reciciva dos espasmos. Não houve óbito e as complicações não foram importantes, sendo, em sua maioria, transitórias e relacionadas à VII e VIII raízes. Em 4 pacientes não encontramos compressão da raiz. Concluimos que, quaisquer sejam as causas do espasmo hemifacial ou mecanismos de ação da cirurgia, os resultados da descompressão microvascular são excelentes, a curto e longo prazo, e superiores aos obtidos pelas demais formas de tratamento clínico ou cirúrgico.

SUMMARY

In a ten year period 53 patients with hemifacial spasm were submitted to 54 microvascular decompression procedures in the posterior fossa. The technique was the same developed by Jannetta and the surgical initial results were considered excellent in 91% of the cases. The follow-up ranges from 60 days to 7 years, with 40 patients followed for more than two years and 16 for more than five years. Only one patient presented late recurrence of the spasms. There was no death nor serious complications which were usually transient and related do the seventh and eight nerve. In four patients we found no compression of the nerve root. We concluded that no matter what the causes of hemifacial spasm or the mechanisms of action of the surgery are the results of microvascular decompression are excellent and superior to all other clinical and surgical methods of treatment.

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REFERÊNCIAS

1. Almeida GM, Teixeira MJ, Salles AFY - Espasmo hemifacial tratamento microcirúrgico. Arq Bras Neurocir 1:89, 1982.

2. Auger RG, Piepgras DG, Laws ER - Hemifacial spasm: result of microvascular decompression o£ the facial nerve in 54 patients. Mayo Clin Proc 61:640, 1986.

3. Battista AF - Hemifacial spasm and blepharospasm: pecutaneous fractional thermolysis of branches of facial nerve. NY State J Med 77:2234, 1977.

4. Bezerra JMF - Espasmo hemifacial: contribuição ao estude clínico, eletrodiagnóstico, neurorradiológico e terapêutico. Tese. Rio de Janeiro, 1985.

5. Campbell E, Keedy C - Hemifacial spasm: a note on the etiology in two cases. J Neurosurg 4:342, 1947.

6. Carvalho RD, Oliveira SV, Rodrigues JC - Espasmo hemifacial: resultados do tratamento cirúrgico em 14 casos. Arq Neuro-Psiquiat (São Paulo) 31:91, 1973.

7. Coleman CC - Surgical treatment of facial spasm. Ann Surg 105:647, 1937.

8. Elston JS - Botulinum toxin treatment of hemifacial spasm. J Neurol Neurosurg Psychiat 49:827, 1986.

9. Ferguson JK - Hemifacial spasm and the facial nucleus. Ann Neurol 4:97, 1978.

10. Gardner WJ, Sava GA - Hemifacial spasm: a reversible pathophysiologic state. J Neurosurg 19:240, 1962.

11. German WJ - Surgical treatment of spasmodic facial tic. Surgery 11:912, 1942.

12. Harris W, Wright AD - Treatment of clonic facial spasm a) by alcohol injection; b) by nerve anastomosis. Lancet 1:657, 1932.

13. Iwakuma T, Matsumoto A, Nakamura N - Hemifacial spasm: comparison of three diferent operative procedures in 110 patients. J Neurosurg 57:753, 3982.

14. Jannetta PJ - Trigeminal neuralgia and hemifacial spasm: etiology and definitive treatment (abstr). Arch Neurol 32:353, 1975.

15. 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 47:321, 1977.

16. Jannetta PJ - Hemifacial spasm. In Samii M, Jannetta PJ (eds): The Cranial Nerves. Springer, Berlin, 1981, pg 486.

17. Kaye AH, Adams CBT - Hemifacial spasm: a long term follow-up of patients treated by posterior fossa surgery and facial nerve wrapping. J Neurol Neurosurg Psychiat 44:1100, 1981.

18. Kao MC, Hung CC, Chen RC - Controlled thermo denervation of the facial nerve in the treatment of hemifacial spasm. Taiwan I Hsueh Hui Tsa 7:226, 1978.

19. Levin JM, Lee JE - Hemifacial spasm due to cerebellopontine angle lipoma: case report. Neurology 37:337. 1987.

20. Loeser JD, Chen J - Hemifacial spasm: treatment by microsurgical facial nerve decompression. Neurosurgery 13:141, 1983.

21. Maroon JC, Lunsford LD, Deeb ZL - Hemifacial spasm due to aneurysmal compression of the facial nerve. Arch Neurol 35:545, 1978.

22. Miyazaki S, Fukushima T - CP angle epidermoid presenting as hemifacial spasm. No To Shinkei 35:951. 1983.

23. Moller AR, Jannetta PJ - Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm. J Neurosurg 66:681, 1987.

24. Nielsen VK, Jannetta PJ - Pathophysiology of hemifacial spasm: III. Effects of facial nerve decompression. Neurology 34:891, 1984.

25. Niemeyer P Filho - Tratamento cirúrgico da nevralgia do trigêmeo, com preservação da sensibilidade Arq Neuro-Psiquiat (São Paulo) 38:1, 1980.

26. Niemeyer P Filho - Descompressão neurovascular na nevralgia do trigêmeo: análise de 70 casos. Arq Neuro-Psiquiat (São Paulo) 41:321, 1983.

27. Niemeyer P Filho - Descompressão neurovascular microcirúrgica: opção no tratamento da nevralgia essencial do trigêmeo. Tese. São Paulo, 1983.

28. Piatt JH Jr, Wilkins RH - Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships. Neurosurgery 14:462, 1984.

29. Pierry A, Cameron M - Chronic hemifacial spasm from posterior fossa arteriovenous malformation. J Neurol Neurosurg Psychiat 42:670, 1979.

30. Ramon F, Moore JW - Ephaptic transmission in squid giant axons. Am J Physiol 234:C162, 1978.

31. Rand RW - Gardner neurovascular decompression of the trigeminal and facial nerves for tic douloureux and hemifacial spasm. Surg Neurol 16:329, 1981.

32. Rhoton AL - Microsurgical neurovascular decompression for trigeminal neuralgia and hemifacial spasm. J Fla Med Assoc 65:425, 1978.

33. Ruby JR, jannetta PJ - Hemifacial spasm: ultrastructural changes in the facial nerve induced by neurovascular compression. Surg Neurol 4:369, 1975.

34. Sampaio P Machado A - Tratamento cirúrgico do espasmo hemifacial: considerações sobre 11 casos. Ara Neuro-Psiquiat (São Paulo) 33:52, 1975.

35 Scoville WB - Partial section of proximal seventh nerve trunk for facial spasm. Surg Gynec Obstetr 10:495, 1955.

36. Wakasugi E - Facial nerve block in the treatment of facial spasm. Arch Otolaryngol 95:356, 1972.

37. Wilson C3, York C, Prioleau G - Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm. West J Med 132:481, 1980.

38. Yen HS, Tew JM Jr, Ramirez RM - Microsurgical treatment of intractable hemifacial spasm. Neurosurgery 9:383, 1981.

Dr. Paulo Niemeyer Filho - Beneficência Portuguesa do Rio de Janeiro, Serviço de Neurocirurgia - Rua Santo Amaro 80 - 22211 Rio de Janeiro RJ - Brasil

1. Almeida GM, Teixeira MJ, Salles AFY - Espasmo hemifacial tratamento microcirúrgico. Arq Bras Neurocir 1:89, 1982.
2. Auger RG, Piepgras DG, Laws ER - Hemifacial spasm: result of microvascular decompression o£ the facial nerve in 54 patients. Mayo Clin Proc 61:640, 1986.
3. Battista AF - Hemifacial spasm and blepharospasm: pecutaneous fractional thermolysis of branches of facial nerve. NY State J Med 77:2234, 1977.
4. Bezerra JMF - Espasmo hemifacial: contribuição ao estude clínico, eletrodiagnóstico, neurorradiológico e terapêutico. Tese. Rio de Janeiro, 1985.
5. Campbell E, Keedy C - Hemifacial spasm: a note on the etiology in two cases. J Neurosurg 4:342, 1947.
6. Carvalho RD, Oliveira SV, Rodrigues JC - Espasmo hemifacial: resultados do tratamento cirúrgico em 14 casos. Arq Neuro-Psiquiat (São Paulo) 31:91, 1973.
7. Coleman CC - Surgical treatment of facial spasm. Ann Surg 105:647, 1937.
8. Elston JS - Botulinum toxin treatment of hemifacial spasm. J Neurol Neurosurg Psychiat 49:827, 1986.
9. Ferguson JK - Hemifacial spasm and the facial nucleus. Ann Neurol 4:97, 1978.
10. Gardner WJ, Sava GA - Hemifacial spasm: a reversible pathophysiologic state. J Neurosurg 19:240, 1962.
11. German WJ - Surgical treatment of spasmodic facial tic. Surgery 11:912, 1942.
12. Harris W, Wright AD - Treatment of clonic facial spasm a) by alcohol injection; b) by nerve anastomosis. Lancet 1:657, 1932.
13. Iwakuma T, Matsumoto A, Nakamura N - Hemifacial spasm: comparison of three diferent operative procedures in 110 patients. J Neurosurg 57:753, 3982.
14. Jannetta PJ - Trigeminal neuralgia and hemifacial spasm: etiology and definitive treatment (abstr). Arch Neurol 32:353, 1975.
15. 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 47:321, 1977.
16. Jannetta PJ - Hemifacial spasm. In Samii M, Jannetta PJ (eds): The Cranial Nerves. Springer, Berlin, 1981, pg 486.
17. Kaye AH, Adams CBT - Hemifacial spasm: a long term follow-up of patients treated by posterior fossa surgery and facial nerve wrapping. J Neurol Neurosurg Psychiat 44:1100, 1981.
18. Kao MC, Hung CC, Chen RC - Controlled thermo denervation of the facial nerve in the treatment of hemifacial spasm. Taiwan I Hsueh Hui Tsa 7:226, 1978.
19. Levin JM, Lee JE - Hemifacial spasm due to cerebellopontine angle lipoma: case report. Neurology 37:337. 1987.
20. Loeser JD, Chen J - Hemifacial spasm: treatment by microsurgical facial nerve decompression. Neurosurgery 13:141, 1983.
21. Maroon JC, Lunsford LD, Deeb ZL - Hemifacial spasm due to aneurysmal compression of the facial nerve. Arch Neurol 35:545, 1978.
22. Miyazaki S, Fukushima T - CP angle epidermoid presenting as hemifacial spasm. No To Shinkei 35:951. 1983.
23. Moller AR, Jannetta PJ - Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm. J Neurosurg 66:681, 1987.
24. Nielsen VK, Jannetta PJ - Pathophysiology of hemifacial spasm: III. Effects of facial nerve decompression. Neurology 34:891, 1984.
25. Niemeyer P Filho - Tratamento cirúrgico da nevralgia do trigêmeo, com preservação da sensibilidade Arq Neuro-Psiquiat (São Paulo) 38:1, 1980.
26. Niemeyer P Filho - Descompressão neurovascular na nevralgia do trigêmeo: análise de 70 casos. Arq Neuro-Psiquiat (São Paulo) 41:321, 1983.
27. Niemeyer P Filho - Descompressão neurovascular microcirúrgica: opção no tratamento da nevralgia essencial do trigêmeo. Tese. São Paulo, 1983.
28. Piatt JH Jr, Wilkins RH - Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships. Neurosurgery 14:462, 1984.
29. Pierry A, Cameron M - Chronic hemifacial spasm from posterior fossa arteriovenous malformation. J Neurol Neurosurg Psychiat 42:670, 1979.
30. Ramon F, Moore JW - Ephaptic transmission in squid giant axons. Am J Physiol 234:C162, 1978.
31. Rand RW - Gardner neurovascular decompression of the trigeminal and facial nerves for tic douloureux and hemifacial spasm. Surg Neurol 16:329, 1981.
32. Rhoton AL - Microsurgical neurovascular decompression for trigeminal neuralgia and hemifacial spasm. J Fla Med Assoc 65:425, 1978.
33. Ruby JR, jannetta PJ - Hemifacial spasm: ultrastructural changes in the facial nerve induced by neurovascular compression. Surg Neurol 4:369, 1975.
34. Sampaio P Machado A - Tratamento cirúrgico do espasmo hemifacial: considerações sobre 11 casos. Ara Neuro-Psiquiat (São Paulo) 33:52, 1975.
35 Scoville WB - Partial section of proximal seventh nerve trunk for facial spasm. Surg Gynec Obstetr 10:495, 1955.
36. Wakasugi E - Facial nerve block in the treatment of facial spasm. Arch Otolaryngol 95:356, 1972.
37. Wilson C3, York C, Prioleau G - Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm. West J Med 132:481, 1980.
38. Yen HS, Tew JM Jr, Ramirez RM - Microsurgical treatment of intractable hemifacial spasm. Neurosurgery 9:383, 1981.

Espasmo hemifacial resultados da descompressão microvascular em 53 pacientes

Hemifacial spasm: results of microvascular decompression in 53 patients

Datas de Publicação

Publicação nesta coleção
25 Maio 2011
Data do Fascículo
Jun 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Almeida GM, Teixeira MJ, Salles AFY - Espasmo hemifacial tratamento microcirúrgico. Arq Bras Neurocir 1:89, 1982.

[2] 2. Auger RG, Piepgras DG, Laws ER - Hemifacial spasm: result of microvascular decompression o£ the facial nerve in 54 patients. Mayo Clin Proc 61:640, 1986.

[3] 3. Battista AF - Hemifacial spasm and blepharospasm: pecutaneous fractional thermolysis of branches of facial nerve. NY State J Med 77:2234, 1977.

[4] 4. Bezerra JMF - Espasmo hemifacial: contribuição ao estude clínico, eletrodiagnóstico, neurorradiológico e terapêutico. Tese. Rio de Janeiro, 1985.

[5] 5. Campbell E, Keedy C - Hemifacial spasm: a note on the etiology in two cases. J Neurosurg 4:342, 1947.

[6] 6. Carvalho RD, Oliveira SV, Rodrigues JC - Espasmo hemifacial: resultados do tratamento cirúrgico em 14 casos. Arq Neuro-Psiquiat (São Paulo) 31:91, 1973.

[7] 7. Coleman CC - Surgical treatment of facial spasm. Ann Surg 105:647, 1937.

[8] 8. Elston JS - Botulinum toxin treatment of hemifacial spasm. J Neurol Neurosurg Psychiat 49:827, 1986.

[9] 9. Ferguson JK - Hemifacial spasm and the facial nucleus. Ann Neurol 4:97, 1978.

[10] 10. Gardner WJ, Sava GA - Hemifacial spasm: a reversible pathophysiologic state. J Neurosurg 19:240, 1962.

[11] 11. German WJ - Surgical treatment of spasmodic facial tic. Surgery 11:912, 1942.

[12] 12. Harris W, Wright AD - Treatment of clonic facial spasm a) by alcohol injection; b) by nerve anastomosis. Lancet 1:657, 1932.

[13] 13. Iwakuma T, Matsumoto A, Nakamura N - Hemifacial spasm: comparison of three diferent operative procedures in 110 patients. J Neurosurg 57:753, 3982.

[14] 14. Jannetta PJ - Trigeminal neuralgia and hemifacial spasm: etiology and definitive treatment (abstr). Arch Neurol 32:353, 1975.

[15] 15. 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 47:321, 1977.

[16] 16. Jannetta PJ - Hemifacial spasm. In Samii M, Jannetta PJ (eds): The Cranial Nerves. Springer, Berlin, 1981, pg 486.

[17] 17. Kaye AH, Adams CBT - Hemifacial spasm: a long term follow-up of patients treated by posterior fossa surgery and facial nerve wrapping. J Neurol Neurosurg Psychiat 44:1100, 1981.

[18] 18. Kao MC, Hung CC, Chen RC - Controlled thermo denervation of the facial nerve in the treatment of hemifacial spasm. Taiwan I Hsueh Hui Tsa 7:226, 1978.

[19] 19. Levin JM, Lee JE - Hemifacial spasm due to cerebellopontine angle lipoma: case report. Neurology 37:337. 1987.

[20] 20. Loeser JD, Chen J - Hemifacial spasm: treatment by microsurgical facial nerve decompression. Neurosurgery 13:141, 1983.

[21] 21. Maroon JC, Lunsford LD, Deeb ZL - Hemifacial spasm due to aneurysmal compression of the facial nerve. Arch Neurol 35:545, 1978.

[22] 22. Miyazaki S, Fukushima T - CP angle epidermoid presenting as hemifacial spasm. No To Shinkei 35:951. 1983.

[23] 23. Moller AR, Jannetta PJ - Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm. J Neurosurg 66:681, 1987.

[24] 24. Nielsen VK, Jannetta PJ - Pathophysiology of hemifacial spasm: III. Effects of facial nerve decompression. Neurology 34:891, 1984.

[25] 25. Niemeyer P Filho - Tratamento cirúrgico da nevralgia do trigêmeo, com preservação da sensibilidade Arq Neuro-Psiquiat (São Paulo) 38:1, 1980.

[26] 26. Niemeyer P Filho - Descompressão neurovascular na nevralgia do trigêmeo: análise de 70 casos. Arq Neuro-Psiquiat (São Paulo) 41:321, 1983.

[27] 27. Niemeyer P Filho - Descompressão neurovascular microcirúrgica: opção no tratamento da nevralgia essencial do trigêmeo. Tese. São Paulo, 1983.

[28] 28. Piatt JH Jr, Wilkins RH - Treatment of tic douloureux and hemifacial spasm by posterior fossa exploration: therapeutic implications of various neurovascular relationships. Neurosurgery 14:462, 1984.

[29] 29. Pierry A, Cameron M - Chronic hemifacial spasm from posterior fossa arteriovenous malformation. J Neurol Neurosurg Psychiat 42:670, 1979.

[30] 30. Ramon F, Moore JW - Ephaptic transmission in squid giant axons. Am J Physiol 234:C162, 1978.

[31] 31. Rand RW - Gardner neurovascular decompression of the trigeminal and facial nerves for tic douloureux and hemifacial spasm. Surg Neurol 16:329, 1981.

[32] 32. Rhoton AL - Microsurgical neurovascular decompression for trigeminal neuralgia and hemifacial spasm. J Fla Med Assoc 65:425, 1978.

[33] 33. Ruby JR, jannetta PJ - Hemifacial spasm: ultrastructural changes in the facial nerve induced by neurovascular compression. Surg Neurol 4:369, 1975.

[34] 34. Sampaio P Machado A - Tratamento cirúrgico do espasmo hemifacial: considerações sobre 11 casos. Ara Neuro-Psiquiat (São Paulo) 33:52, 1975.

[35] 35 Scoville WB - Partial section of proximal seventh nerve trunk for facial spasm. Surg Gynec Obstetr 10:495, 1955.

[36] 36. Wakasugi E - Facial nerve block in the treatment of facial spasm. Arch Otolaryngol 95:356, 1972.

[37] 37. Wilson C3, York C, Prioleau G - Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm. West J Med 132:481, 1980.

[38] 38. Yen HS, Tew JM Jr, Ramirez RM - Microsurgical treatment of intractable hemifacial spasm. Neurosurgery 9:383, 1981.