Anterior inferior cerebellar artery (AICA) compression is a common cause of hemifacial spasm (HFS). Endoscopic-assisted microvascular decompression (eMVD) offers several advantages, including minimal invasiveness, wide viewing angles, and clear visualization. The surgical procedure was performed under a four-step endoscopic technique. Step 1: A 0° endoscope was used to dissect the cerebellopontine cistern and release cerebrospinal fluid for decompression. Step 2: A 30° endoscope was employed to dissect the arachnoid around the facial nerve and expose the root exit zone (REZ). Step 3: The AICA was identified, carefully dissected, and transposed away from the REZ. Step 4: Adequate decompression and hemostasis were confirmed. The four-step endoscopic approach can achieve effective decompression in cases of HFS caused by AICA compression, providing favorable surgical outcomes.

A clinical nomogram for predicting recurrence after percutaneous radiofrequency ablation in the management of primary hemifacial spasm.

Quantitative intraoperative lateral spread response amplitudes in hemifacial Spasm: Associations with vascular burden.

Fourth ventricular hamartomas (FVHs) are extremely rare lesions, and their association with refractory epilepsy is often underrecognized. We present a pediatric case of cerebellar-origin epilepsy with complete seizure remission after surgical resection, followed by a literature-based discussion of diagnostic and therapeutic considerations. We describe a 9-year-old female with drug-resistant epilepsy since infancy. She was diagnosed with a fourth ventricular roof hamartoma (FVRH), and after two previous surgeries with no improvement, a third procedure at our institution achieved total resection. The patient has remained seizure-free for 2 years, with significant cognitive and behavioral improvement. FVHs may present with focal motor seizures, myoclonus, hemifacial spasms, or neurodevelopmental delay. Diagnosis requires integration of MRI findings, functional imaging (SPECT/PET), and EEG-though these often yield nonspecific results. These lesions are typically resistant to pharmacologic therapy, and surgical resection is associated with high seizure control rates. Emerging minimally invasive techniques, such as laser interstitial thermal therapy (LITT), show promise. Importantly, roof FVHs differ from floor (tegmental) hamartomas in their anatomical origin, clinical presentation, and surgical approach-the latter often being associated with hypothalamic or brainstem symptoms, while roof lesions more commonly manifest with cerebellar-related epileptogenic activity. Early recognition of FVRHs as potential epileptogenic foci and timely surgical intervention can lead to seizure freedom and favorable neurodevelopmental outcomes. This case reinforces the role of cerebellar lesions in pediatric epilepsy and supports aggressive surgical management when feasible.

Botulinum toxin therapy for neurological disorders: Serendipitous benefits on sleep quality and underlying mechanisms.

Cervical plexus block (CPB) provides postoperative analgesia and reduces postoperative nausea and vomiting (PONV), which are important for improving the quality of recovery after head and neck surgical procedures. This randomized controlled trial investigated the effect of superficial CPB on early postoperative quality of recovery in patients undergoing microvascular decompression (MVD). Patients undergoing MVD for trigeminal neuralgia and hemifacial spasm were randomly assigned to receive superficial CPB or not (n = 30 per group). Ultrasound-guided superficial CPB was performed with 10cc of 0.5% ropivacaine before surgery. The primary outcome measure was the Korean version of the 15-item Quality of Recovery (QoR-15K) score on postoperative day 1. The secondary outcome measures included postoperative pain scores, the incidence of PONV, and perioperative inflammatory cytokine levels. The QoR-15K score on postoperative day 1 did not show a significant difference (94.5 [68.0-116.0] vs. 80.5 [51.5-100.8], P = 0.077) between the 2 groups. Perioperative QoR-15K scores also showed no significant time × group effect (P = 0.324). Postoperative pain scores did not differ between the 2 groups. The incidence of PONV was significantly reduced in the superficial CPB group at 6 (P = 0.001) and 12 (P < 0.001) hours postoperatively. Perioperative inflammatory cytokine levels showed no differences between the 2 groups. Superficial CPB did not improve early postoperative QoR in patients undergoing MVD. However, it reduced the incidence of PONV during the early postoperative period, which could potentially enhance patient comfort and satisfaction.

Introduction: Microvascular decompression (MVD) is the gold standard treatment for hemifacial spasm (HFS), but it carries a risk of auditory morbidity, primarily due to lateral traction on the eighth cranial nerve during exposure of the facial nerve. This study aimed to: (1) assess the incidence and mechanisms of hearing loss during MVD for HFS; (2) identify critical intraoperative changes in brainstem auditory evoked potentials (BAEPs) that predict postoperative outcomes; and (3) define practical intraoperative warning thresholds.Method: We retrospectively analyzed 100 patients undergoing MVD for HFS, including 84 with detailed intraoperative BAEP recordings and 34 earlier cases. BAEPs were continuously monitored, focusing on Wave I–V interpeak latency, Wave V latency shifts, and amplitude changes. Pre- and postoperative auditory function was evaluated using pure tone average (PTA). Correlations between intraoperative changes and hearing outcomes were analyzed to identify risk thresholds.Result: Hearing was preserved in 88% of monitored patients. Hearing loss occurred in 9.5%, and complete deafness in 2.3%. Wave V latency delay was the most sensitive intraoperative marker. Mean delay was 0.61 ms (±0.36) in patients without hearing loss, and 1.05 ms (±0.64) in those with hearing decline. Wave V abolition was associated with permanent deafness. Most BAEP changes occurred during cerebellar retraction. Earlier cases without systematic monitoring showed a higher deafness rate (3/7) than later ones (2/93).Discussion: BAEP monitoring reduces the risk of hearing loss by detecting reversible changes during MVD. We propose three intraoperative warning thresholds: • 0.4 ms Wave V delay – “watching” • 0.6 ms – “warning” • 1.0 ms or BAEP loss – “critical” These thresholds help prevent irreversible auditory damage in functional neurosurgery.

Hemifacial spasm (HFS) is a chronic neurological disorder characterized by involuntary contractions of the facial muscles and is often accompanied by psychoemotional disturbances and a decreased quality of life. The aim of this study was to assess the levels of depression, anxiety, and quality of life in patients with HFS, as well as to determine the relationship between the frequency of spasms and psychoemotional distress. Keywords: Hemifacial Spasm, Psychoemotional State, Depression, Anxiety, Quality of Life, Facial Muscle Spasms, SF-36, HDRS, HADS

The article is devoted to the study of metabolic and neurochemical factors influencing the pathogenesis of hemifacial spasm (HFS).The levels of vitamin B₁₂, cortisol, and dopamine were determined in patients with HFS and compared with those in a control group. Significant correlations were established between decreased vitamin B₁₂ levels, hyperactivity of the hypothalamic–pituitary–adrenal axis, and disturbances in neurotransmitter processes. The findings confirm the involvement of vitamin B₁₂ deficiency in the disruption of neurovascular interactions, which contributes to the development of chronic pathological spasm of the facial muscles and defines directions for comprehensive patient rehabilitation. Keywords: Hemifacial Spasm, Vitamin B₁₂, Dopamine, Cortisol, Neurotransmitter Imbalance, Metabolic Markers, Neurovascular Dysfunction, Rehabilitation

BackgroundThe application value of intraoperative lateral spreading response (LSR) during microvascular decompression (MVD) is always disputed. The current study aimed to explore the predictive value of intraoperative LSR monitoring for the long-term outcome in patients with primary hemifacial spasm (pHFS).MethodsThe data from 312 pHFS patients were retrospectively reviewed. The zygomatic LSR (ZYG-LSR) and mandibular LSR (MAN-LSR) monitoring were performed during surgery. The correlations of ZYG-LSR and MAN-LSR disappearances with patients’ long-term outcomes (one year after surgery) were retrospectively investigated. Consequently, binary logistic regression analysis was applied to explore their predictive value. Finally, the implications of their combined utilization for predicting the long-term outcome were explored.ResultsPatients with either persistent ZYG-LSR or MAN-LSR exhibited a higher incidence of spasms one year after surgery (p < 0.001). Persistent ZYG-LSR (odds ratio 7.721, p < 0.001) and MAN-LSR (odds ratio 10.729, p < 0.001) were both identified as independent predictive factors for an unfavorable long-term outcome. Taking both ZYG-LSR and MAN-LSR into consideration, patients with simultaneously disappeared two waves had the highest long-term recovery rate (97.2%), followed by patients with either persisted wave (76.5%) and patients with simultaneously persisted two waves (27.3%). The differences among all pairwise comparisons were statistically significant (p < 0.001 for all).ConclusionThe current study confirmed the application value of intraoperative LSR monitoring during MVD in patients with pHFS. In addition, the clinical significance of two-branch LSR monitoring was also described. The findings can provide important insights for optimizing the application of intraoperative LSR monitoring in clinical practice.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40001-025-03293-w.

Many patients with hemifacial spasm (HFS) undergo botulinum toxin injections (BTI) as an initial treatment and later undergo microvascular decompression (MVD), typically a more definitive treatment. However, in some cases, spasms recur after MVD, and patients may benefit from redo MVD. The impact of preoperative BTI on spasm freedom after redo MVD remains unclear. This study aims to further investigate this relationship and determine factors which affect redo MVD outcomes. In a retrospective cohort study, an adjusted ordinal logistic regression model was used to identify factors associated with spasm freedom after redo MVD of the facial nerve, including age, sex, laterality, preoperative BTI, number of prior MVDs, type of neurovascular conflict, and offending vessel. Of the 102 patients with HFS who underwent redo MVD with a minimum of 2 years of follow-up (mean 6.8 years), 75 achieved complete spasm freedom (73.5%) and 12 (11.8%) experienced >75% spasm relief. There were no significant associations between MVD outcomes and age (P = .32), sex (P = .93), laterality (P = .24), and preoperative BTI (P = .29). Notably, multiple prior MVDs predicted poorer response (P = .011). The presence of posterior inferior cerebellar artery (P = .010) and neurovascular compression (P = .00008) were associated with better spasm outcomes. While patients with a history of multiple prior MVDs tended to benefit less from redo MVD, the number of preoperative BTI was not associated with spasm freedom after the procedure. These findings suggest that, in cases of spasm recurrence after MVD, HFS can be managed by BTI without compromising the effectiveness of subsequent redo MVD.

Hemifacial spasm in the Middle East: Insights from a high-volume tertiary care center.

Diabetic striatopathy is a rare, acute neurological complication of diabetes mellitus which presents with non-ketotic hyperglycemia and involuntary movements, specifically hemichorea or hemiballismus. Striatal abnormalities on neuroimaging have been reported in most, but not all cases. This case report aims to increase awareness that diabetic striatopathy can be a presenting symptom of diabetes mellitus.A 92-year-old Filipino female with no history of diabetes presented with acute onset of focal clonic flexion of the left upper extremity for a few hours, which progressed to right hemifacial spasm. She was diagnosed with a hyperosmolar hyperglycemic state and was treated accordingly. Cranial CT scan findings were unremarkable. There was an immediate resolution of her neurologic symptoms after the correction of hyperglycemia.The diagnosis of diabetic striatopathy highlights the importance of increasing awareness and understanding of this condition among clinicians to prevent delayed diagnosis and treatment. Screening for hyperglycemia is advisable for patients with involuntary movements. The prognosis for diabetic striatopathy is good with prompt glycemic control in most cases.

Introduction We present a unique case of the callosal variant of alien limb phenomenon, manifesting as an “alien foot” in the setting of a splenial corpus callosum infarction. Case Presentation 55‐year‐old female with past medical history of HTN, TIA , HLD, DM initially presented to ED with several days of right‐sided headache associated with right face paresthesias, intermittent right hemifacial spasms involving right face, eyes, lower jaw, lasting about 1‐2 minutes. Initial CTH &amp; CTP were unremarkable. CTA revealed stenosis of R A1, R P2, &amp; L P2 segments. MRI demonstrated signal changes in splenium bilaterally. She continued to report intermittent headaches even with verapamil and thus stat CTH was performed revealing new hypodensities in right corpus callosum. Repeat MRI brain showed acute infarct in right paramedian frontal lobe and splenium of corpus callosum. Patient underwent IR guided to rule out vasculitis. DSA demonstrated right proximal A1 severe &amp; b/l PCA Stenosis. CSF Results WBC 0, RBC 18, PRO 49, GLU 88; negative for any infective workup: VDRL, viral etiology, gram staining, west nile, toxoplasmosis, borrelia, VZV; ACE level, IgG index and Meningitis film array. Patient underwent angioplasty for R A1 Stenosis and was eventually discharged home after clinical stabilization and prolonged monitoring. Patient presented after three months to ED with chief complaint of weird feeling in right part of her brain in which her right upper and lower extremity were not following her will or voluntary commands of going to the restroom by turning to right and even after thinking about it, she felt that her right leg and hand were not acting synergistically to follow her wishes. Discussion Alien limb phenomenon typically arises later in the course of stroke recovery and is most commonly associated with anterior or posterior cerebral artery infarcts. It involves the perception of a limb as foreign, accompanied by involuntary motor activity, and may be associated with apraxia, intermanual conflict, or self‐restriction. Callosal AHS results from anterior corpus callosum lesions and leads to hemispheric disconnection, especially during tasks requiring dominant hemisphere control. In this patient, the infarct involved the right paramedian frontal lobe and splenium, within the ACA territory. Her symptoms of intermanual conflict and apraxia are consistent with the callosal variant of AHS. Conclusion Further characterization of involuntary movements in brain‐injured patients may offer valuable insights into motor control, awareness, and reorganization following cerebral injury. image

Background: The coexistence of trigeminal neuralgia and hemifacial spasm is rare, usually caused by neurovascular compression. Although microvascular decompression is standard treatment, it can cause recurrence and complications. Korean medicine may be a complementary treatment option.Case: A 68-year-old woman developed right-sided trigeminal neuralgia with superior cerebellar artery contact at the trigeminal root and left-sided hemifacial spasm after right temporal lobe infarction. Despite pharmacotherapy, pain and spasms persisted.Interventions: During 22-day hospitalization, she received Igigeopoong-san-gami (combined with Oryeong-san), acupuncture, and placental pharmacopuncture. Although carbamazepine and gabapentin were maintained, duloxetine, tramadol, and naproxen were discontinued. This case followed the CARE guidelines.Outcomes: Pain improved (Numerical Rating Scale 5→1; BNI pain scale IV→II), and spasm resolved (Scott's description 3→0) without adverse events.Conclusion: Integrative Korean medicine may benefit patients with concurrent trigeminal neuralgia and hemifacial spasm after stroke. Large-scale, multicenter, prospective studies with long-term follow-up are warranted.

Efficacy of endoscope in microvascular decompression surgery for hemifacial spasm: Report of 2 cases

Patient-Perceived Response to Medical Treatment in Hemifacial Spasm.

ObjectiveThis study aims to examine the impact of preoperative sleep disturbances on postoperative pain levels among individuals undergoing hemifacial spasm (HFS) surgery. The findings will establish a theoretical foundation for developing targeted interventions to ameliorate postoperative pain management in this patient population.MethodsHemifacial spasm patients who were treated and operated on at Peking University People’s Hospital from October 2023 to February 2024 were selected as participants via convenience sampling. Sleep quality was quantitatively assessed using the Pittsburgh Sleep Quality Index (PSQI), while postoperative pain severity was measured with the Numerical Rating Scale (NRS). Perioperative clinical data were systematically recorded at postoperative day 1, 3, and 7 (POD 1, 3, and 7). Univariate and multivariate regression analyses were subsequently conducted to identify predictors of moderate-to-severe pain persisting at the 1-week postoperative timepoint.ResultsA cohort of 120 patients diagnosed with hemifacial spasm participated in this study. Based on preoperative Pittsburgh Sleep Quality Index (PSQI) scores, participants were stratified into two groups: a low-sleep-quality group (PSQI ≥ 7, n = 25) and a high-sleep-quality group (PSQI < 7, n = 95). At POD 7, a total of 22 patients (18.33%) developed moderate-to-severe pain (NRS ≥ 4). Univariate analysis revealed that the pain incidence was significantly higher in the poor sleep quality group (PSQI ≥ 7) compared to the good sleep quality group (44.0% vs. 11.58%, p = 0.006). After adjusting for confounding variables, multivariate analysis confirmed that preoperative sleep disturbance (PSQI score) was an independent risk factor for postoperative pain (adjusted OR = 1.368, 95% CI: 1.154–1.621, p < 0.001). Each 1-point increase in PSQI score was associated with a 36.8% increase in pain risk. Sensitivity analysis using dichotomized PSQI variables (cut-off values ≥5 or ≥7) yielded consistent results, showing significantly increased pain risk in the poor sleep quality group (OR = 6.263 and 6.419, respectively, both p = 0.001), supporting the robustness of the primary analysis findings.ConclusionPreoperative sleep disturbances elevate the risk of patients with hemifacial spasm experiencing moderate-to-severe pain postoperatively. Therefore, proactive management of sleep disturbances prior to surgery represents a valuable strategy for enhancing postoperative analgesia in this patient population. However, the generalizability of these findings is limited to HFS patients undergoing MVD, and further validation in broader surgical cohorts is warranted.

Adhesive materials are widely used in microvascular decompression for treating neurovascular compression syndromes. They play an important role in the critical step of vessel fixation. Recently, completely autologous fibrin glue produced solely from a patient's own plasma was developed. It can theoretically reduce the risks of viral or prion transmission and allergic reactions, while potentially providing more stable long-term adhesion. This study reports our initial experience with completely autologous fibrin glue in microvascular decompression and evaluates its efficacy and safety. Twenty-seven consecutive patients (12 with trigeminal neuralgia and 15 with hemifacial spasm) underwent microvascular decompression using autologous fibrin glue, including 8 trigeminal neuralgia treated using a fully endoscopic supracerebellar infratentorial approach. Autologous cryoprecipitate and thrombin were prepared (average: 4.8 mL each) from preoperative blood collection (average: 388.9 mL) without adverse events. All offending arteries, including 5 vertebral arteries, were securely transposed using polytetrafluoroethylene and autologous fibrin glue. The fibrin glue was also used to support dural closure with a collagen matrix. All patients experienced complete symptom relief, with no need for postoperative medication, except for 1 patient with mild recurrence despite maintained vascular fixation confirmed on magnetic resonance imaging. No new permanent neurological deficits, cerebrospinal fluid leakage, infections, allergic reactions, or systemic complications were observed. These findings suggest that completely autologous fibrin glue is safe and effective for both vessel fixation and dural sealing in microvascular decompression, without complications related to its use.

Anatomic variations in the posterior fossa are influenced by mastoid pneumatization and sigmoid sinus development. Accurate identification of the sigmoid sinus location is crucial for precise craniotomy during microvascular decompression (MVD) for hemifacial spasm (HFS).We investigated individual variations in the bony eminence between the occipitomastoid suture and the digastric groove (the inferior retrosigmoid eminence, IRE) and its relationship to the sigmoid sinus.A retrospective review was conducted on 104 patients who underwent MVD for HFS. Radiological findings, demographic data, and operative videos were used to examine the anatomical characteristics of the IRE.The IRE was identified in 99 patients (95.2%) using three-dimensional computed tomography (3DCT). It has an average width of 5.5 mm and a height of 6.25 mm. The mean distance from the medial margin of the sigmoid sinus was 0 mm. Craniotomy involving the IRE was performed in 44.2% of cases, and mastoid air cells were opened in 26.9%. Postoperative resolution of HFS was immediately observed in 87 patients (83.7%) and 103 patients (99%) at the one-year follow-up.Recognizing anatomical variations of the IRE is valuable for estimating the location of the inferior sigmoid sinus. The IRE aligns with the medial margin of the lower sigmoid sinus, which could serve as a reliable bony landmark.