Espasmo hemifacial: resultados do tratamento cirúrgico em 14 casos

Carvalho, Rui R. D.; Oliveira, Salvador V.; Rodrigues, Juan R. C.

doi:10.1590/S0004-282X1973000200002

Resumos

Quatorze pacientes com espasmo hemifacial foram submetidos a exploração cirúrgica e neurolise do 7º par craniano no ângulo ponto-cerebelar. Em 7 pacientes havia indubitável compressão do nervo facial por alça anômala da artéria cerebelar anterior e inferior sendo que um paciente também apresentava malformação de Arnold-Chiari. Em um paciente havia aracnoidite envolvendo o nervo. Em 6 outros, o nervo achava-se aparentemente livre. Houve alívio imediato e duradouro do espasmo em 10 pacientes, 2 permaneceram inalterados e um apresentou recidiva após 10 meses. Houve um óbito no pós-operatório imediato, conseqüente a traumatismo craniano por queda do paciente.

Fourteen patients with hemifacial spasm were submitted to surgical exposure and neurolysis of the seventh nerve at the cerebellopontine angle. Seven patients had an anomalous anterior inferior cerebellar artery pulsating on the nerve, being present in one patient also Arnold-Chiari malformation. Another patient had chronic arachnoiditis involving the facial nerve. In 6 patients no abnormalities were found in the posterior fossa. There was complete relief of the spasm in 10 patients, 2 were unchanged, 1 had recurrence 10 months later and 1 died in the post-operative period due to head injury sustained during a fall.

Espasmo hemifacial: resultados do tratamento cirúrgico em 14 casos

Hemifacial spasm: report of 14 cases submitted to surgical treatment

Rui R. D. Carvalho^I; Salvador V. Oliveira^II; Juan R. C. Rodrigues^II

^IDisciplina de Neurocirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo: Professor

^IIDisciplina de Neurocirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo: Assistentes

RESUMO

Quatorze pacientes com espasmo hemifacial foram submetidos a exploração cirúrgica e neurolise do 7º par craniano no ângulo ponto-cerebelar. Em 7 pacientes havia indubitável compressão do nervo facial por alça anômala da artéria cerebelar anterior e inferior sendo que um paciente também apresentava malformação de Arnold-Chiari. Em um paciente havia aracnoidite envolvendo o nervo. Em 6 outros, o nervo achava-se aparentemente livre. Houve alívio imediato e duradouro do espasmo em 10 pacientes, 2 permaneceram inalterados e um apresentou recidiva após 10 meses. Houve um óbito no pós-operatório imediato, conseqüente a traumatismo craniano por queda do paciente.

SUMMARY

Fourteen patients with hemifacial spasm were submitted to surgical exposure and neurolysis of the seventh nerve at the cerebellopontine angle. Seven patients had an anomalous anterior inferior cerebellar artery pulsating on the nerve, being present in one patient also Arnold-Chiari malformation. Another patient had chronic arachnoiditis involving the facial nerve. In 6 patients no abnormalities were found in the posterior fossa. There was complete relief of the spasm in 10 patients, 2 were unchanged, 1 had recurrence 10 months later and 1 died in the post-operative period due to head injury sustained during a fall.

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Disciplina de Neurocirurgia Faculdade de Ciências Médicas da Santa Casa Rua Cesário Motta Junior 112 01221 São Paulo, SP Brasil.

1. CAMBELL, E. & KEEDY, C. Hemifacial spasm: a note on the etiology in two cases. J. Neurosurg. 4:342, 1947.
2. CUSHING, H. Tumors of the Nervus Acusticus and the Syndrome of the Cerebellopontile Angle. Hafner Publishing Co., New York-London, 1963.
3. ECKMAN, P.; KRAMER, R. A. & ALTROCCHI, P. H. Hemifacial spasm. Arch. Neurol. (Chicago) 25:81, 1971.
4. EHNI, G. & WOLTMAN, H. W. Hemifacial spasm. Arch. Neurol. Psychiat. (Chicago) 53:205, 1945.
5. GARDNER, W. J. Trigeminal neuralgia. In Clinical Neurosurgery, Vol. 15, Edited by Ojeman, R. G.. The Williams & Wilkins Co., Baltimore, 1968.
6. GARDNER, W. J. & DOHN, D. F. Trigeminal neuralgia, hemifacial spasm, Paget's disease. Significance of this association. Brain 89:555, 1966.
7. GARDNER, W. J. & SAVA, G. A. Hemifacial spasm a reversible pathophysiologic state. J. Neurosurg. 19:240, 1962.
8. GERMAN, W. J. Surgical treatment of spasmodic facial tic. Surgery 11:912, 1942.
9. GREENWOOD, J. The surgical treatment of hemifacial spasm. J. Neurosurg. 3:506, 1946.
10. HARRIS, W. & WRIGHT, A. D. Treatment of clonic facial spasm. Lancet 1:657, 1932.
11. KEMPE, L. G. & SMITH, D. R. Trigeminal neuralgia, facial spasm, intermedius and glossopharyngeal neuralgia with persistent carotid basilar anastomosis. J. Neurosurg. 31:445, 1969.
12. KRAUSE, F. Chirurgie du Cerveau et de la Moelle Épinière. Tome II. Société D'Éditions Scientifiques et Médicales, Paris, 1912.
13. LAINE, M. E. & NAYRAC, M. Hémispasme facial guéri par intervention sur la fosse postérieure. Rev. Neurol. (Paris) 80:38, 1948.
14. MAGUN, R. & ESSLEN, E. Electromyographic study of reinnervated muscle and of hemifacial spasm. Amer. J. Phys. Med. 38:79, 1959.
15. NOSIK, W. A. & WEIL, A. A. Selective partial neurectomy in hemifacial spasm and the electrophysiologic selection of patients. J. Neurosurg. 13:596, 1956.
16. POPPEN, J. L. An Atlas of Neurosurgical Techniques. W. B. Saunders Co., Philadelphia-London, 1960.
17. SCOVILLE, W. B. Partial section of proximal seventh nerve trunk for facial spasm. Surg. Gynec. Obstet. 101:495, 1955.
18. TEASDAL, R. D. & SALMAN, S. D. Mass facial movements: electromyographic evidence for misdirection. Neurology (Minneapolis) 21:652, 1971.
19. WARTENBERG, R. Hemifacial spasm. A clinical and pathophysiological study. Oxford University Press, New York, 1952.
20. WILSON, S. A. K. Edited by Bruce, A. N. Neurology, Volume 3. Butterworth & Co. Ltd., London, 1955.

Datas de Publicação

Publicação nesta coleção
15 Abr 2013
Data do Fascículo
Jun 1973

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

[1] 1. CAMBELL, E. & KEEDY, C. Hemifacial spasm: a note on the etiology in two cases. J. Neurosurg. 4:342, 1947.

[2] 2. CUSHING, H. Tumors of the Nervus Acusticus and the Syndrome of the Cerebellopontile Angle. Hafner Publishing Co., New York-London, 1963.

[3] 3. ECKMAN, P.; KRAMER, R. A. & ALTROCCHI, P. H. Hemifacial spasm. Arch. Neurol. (Chicago) 25:81, 1971.

[4] 4. EHNI, G. & WOLTMAN, H. W. Hemifacial spasm. Arch. Neurol. Psychiat. (Chicago) 53:205, 1945.

[5] 5. GARDNER, W. J. Trigeminal neuralgia. In Clinical Neurosurgery, Vol. 15, Edited by Ojeman, R. G.. The Williams & Wilkins Co., Baltimore, 1968.

[6] 6. GARDNER, W. J. & DOHN, D. F. Trigeminal neuralgia, hemifacial spasm, Paget's disease. Significance of this association. Brain 89:555, 1966.

[7] 7. GARDNER, W. J. & SAVA, G. A. Hemifacial spasm a reversible pathophysiologic state. J. Neurosurg. 19:240, 1962.

[8] 8. GERMAN, W. J. Surgical treatment of spasmodic facial tic. Surgery 11:912, 1942.

[9] 9. GREENWOOD, J. The surgical treatment of hemifacial spasm. J. Neurosurg. 3:506, 1946.

[10] 10. HARRIS, W. & WRIGHT, A. D. Treatment of clonic facial spasm. Lancet 1:657, 1932.

[11] 11. KEMPE, L. G. & SMITH, D. R. Trigeminal neuralgia, facial spasm, intermedius and glossopharyngeal neuralgia with persistent carotid basilar anastomosis. J. Neurosurg. 31:445, 1969.

[12] 12. KRAUSE, F. Chirurgie du Cerveau et de la Moelle Épinière. Tome II. Société D'Éditions Scientifiques et Médicales, Paris, 1912.

[13] 13. LAINE, M. E. & NAYRAC, M. Hémispasme facial guéri par intervention sur la fosse postérieure. Rev. Neurol. (Paris) 80:38, 1948.

[14] 14. MAGUN, R. & ESSLEN, E. Electromyographic study of reinnervated muscle and of hemifacial spasm. Amer. J. Phys. Med. 38:79, 1959.

[15] 15. NOSIK, W. A. & WEIL, A. A. Selective partial neurectomy in hemifacial spasm and the electrophysiologic selection of patients. J. Neurosurg. 13:596, 1956.

[16] 16. POPPEN, J. L. An Atlas of Neurosurgical Techniques. W. B. Saunders Co., Philadelphia-London, 1960.

[17] 17. SCOVILLE, W. B. Partial section of proximal seventh nerve trunk for facial spasm. Surg. Gynec. Obstet. 101:495, 1955.

[18] 18. TEASDAL, R. D. & SALMAN, S. D. Mass facial movements: electromyographic evidence for misdirection. Neurology (Minneapolis) 21:652, 1971.

[19] 19. WARTENBERG, R. Hemifacial spasm. A clinical and pathophysiological study. Oxford University Press, New York, 1952.

[20] 20. WILSON, S. A. K. Edited by Bruce, A. N. Neurology, Volume 3. Butterworth & Co. Ltd., London, 1955.