Neurosurgical Consultants: Cranial Nerve Disorders: Hemifacial Spasm

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HEMIFACIAL SPASM

Hemifacial Spasm is a painless neurological condition, affecting the 7th (or "Facial") Cranial Nerve, which supplies many of the muscles of the face. The facial muscles affected are those involved in movements that express emotion. These include muscles of the forehead, eye closing mechanisms, as well as muscles around the mouth. Patients with "Hemifacial Spasm" experience repetitive episodes of uncontrollable and involuntary muscle spasms in the face. It frequently begins around the eye and/or corner of the mouth and at some later date spreads to involve the rest of the face (on the one side). This condition is the result of a pressure injury to the "Facial Nerve" as it leaves the Brainstem. Usually a blood vessel is the cause of the pressure on the nerve which produces the injury to the Myelin in a manner similar to that seen in Trigeminal Neuralgia; however, there is NO PAIN associated with Hemifacial Spasm.

DIAGNOSIS

The diagnosis becomes quite evident by the characteristic features of the muscle contractions of one side of the face, commonly beginning around the eye and/or one corner of the mouth. "Thin Slice" MRI and MRA are imperative first steps in the investigation of this condition (just as with Trigeminal Neuralgia and Glossopharyngeal Neuralgia.)

TREATMENT

The treatment of Hemifacial Spasm includes a similar operation to the Microvascular Decompression (MVD) procedure described for Trigeminal Neuralgia and Glossopharyngeal Neuralgia. The Facial (or 7th cranial) Nerve is located approximately one half inch below the Trigeminal (Fifth Cranial) Nerve. The MVD operation is conducted through a small "Key-hole" skull opening in a similar location as described for Trigeminal Neuralgia. In Hemifacial Spasm the ideal treatment results in the relief of the muscle spasm without resorting to destructive operations which produce paralysis of the facial muscles on the one side affected. Unfortunately, medical treatment (usually with Tegretol, Dilantin or any other anticonvulsant drug) is very much less effective in Hemifacial Spasm than in Trigeminal Neuralgia.

The intent of the MVD procedure is to PRESERVE MOTOR FUNCTION to the face while RELIEVING MUSCLE SPASM.

Figure 1: Operative Photo for Right Hemifacial Spasm
The 7th cranial nerve is compressed by a collection of arteries (Arrow) at its junction with the Brainstem.

Figure 2: Operative Photo (same patient) The 7th Cranial Nerve has been "decompressed" by transposing the offending arteries away from the nerve and interposing several Ivalon (permanent) sponges (Arrow) to protect the nerve.
This young lady's symptoms were immediately and completely relieved.