Presurgical evaluation of hemifacial spasm and spasmodic torticollis caused by a neurovascular conflict from AICA with 3T MRI integrated by 3D drive and 3D TOF image fusion: A case report and review of the literature.

Concetta Alafaci,Francesca Granata,Mariano Cutugno,Francesco Tomasello,Francescom Salpietro,Giovanni Grasso

doi:10.4103/2152-7806.136887

Abstract

Background:Hemifacial spasm (HS) and spasmodic torticollis (ST) are well-known disorders that are caused by a neurovascular conflict. HS is characterized by irregular, involuntary muscle contractions on one side of the face due to spasms of orbicularis oris and orbicularis oculi muscles, and is usually caused by vascular compression of the VII cranial nerve. ST is an extremely painful chronic movement disorder causing the neck to involuntary turn to the side, upward and/or downward. HS is usually idiopathic but it is rarely caused by a neurovascular conflict with the XI cranial nerve.Case Description:We present a case of a 36-year-old woman with a 2-year history of left hemifacial spasm and spasmodic torticollis. Pre-surgical magnetic resonance imaging MRI examination was performed with 3TMRI integrated by 3Ddrive and 3DTOF image fusion. Surgery was performed through a left suboccipital retrosigmoid craniectomy. The intraoperative findings documented a transfixing artery penetrating the facial nerve and a dominant left anteroinferior cerebellar artery (AICA) in contact with the anterior surface of the pons and lower cranial nerves. Microvascular decompression (MVD) was performed. Postoperative course showed the regression of her symptoms.ConclusionsTransfixing arteries are rarely reported as a cause of neurovascular conflicts. The authors review the literature concerning multiple neurovascular conflicts.

Highlights

ConclusionsTransfixing arteries are rarely reported as a cause of neurovascular conflicts. The authors review the literature concerning multiple neurovascular conflicts
Hemifacial spasm (HS) and spasmodic torticollis (ST) are well‐known disorders that are caused by a neurovascular conflict
The facial nerve is usually offended by the anteroinferior cerebellar artery (AICA) and the XI cranial nerve by the posteroinferior cerebellar artery (PICA).[2]

Summary

Conclusions

Transfixing arteries are rarely reported as a cause of neurovascular conflicts. The authors review the literature concerning multiple neurovascular conflicts. MRI basal examination showed a dominant left AICA in contact with ipsilateral IX, X and XI cranial nerves. Bidimensional image fusion was subsequently performed and another anomalous contact between a small AICA distal branch and the left facial nerve was demonstrated. To visualize the neurovascular conflict between AICA and lower cranial nerves [Figure 1], the nervous structures were displayed in blue color and the arterial vessels in red. To visualize the neurovascular conflict between AICA distal branch and facial nerve [Figure 2], the nervous structures and distal arteries were displayed in red color and the main arterial vessels in yellow. Microvascular decompression was performed with small pieces of autologous muscle at the point in which the transfixing artery penetrated the nerve, and between AICA, lower cadbe Figure 1: Anteroinferior cerebellar artery (AICA) – IX, Xand XI c.n. at the intracisternal tract. At 4 months of follow‐up the patient had completely recovered

DISCUSSION

CONCLUSIONS