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PubMed1990

[Monitoring of auditory brainstem response (ABR) during microvascular decompression (MVD): results in 400 cases].

In recent years, microvascular decompression (MVD) has been well established as a definitive surgical procedure in the management of hemifacial spasm (HFS) and trigeminal neuralgia (TN). With careful microsurgical technique, MVD can be performed accurately without significant morbidity. However, some incidence of postoperative hearing disturbance has been reported as one the annoying complications. In order to avoid complications of the 8th nerve, we have been using intraoperative monitoring of auditory brainstem response (ABR) for the past 5 years. This report presents the results of ABR monitoring in our personal series of 400 MVD cases. Our clinical results consist of 225 HFS and 175 TN, who underwent recording of ABR before, during and after MVD, including audiometry before and after the operation. There are 107 males and 293 females with the age ranging between 22 and 79, averaging 55 years old. Under routine general endotracheal anesthesia, the patient was placed in a lateral position and a small retromastoid opening was made. Pieces of teflon tape and fibrin glue was used to transpose, reposition and fixate the offending vessels. We used CADWELL 5200 and recorded ABR with needle electrode and click sound averaging 1500 times. ABR recordings were performed on admission, at the beginning of the operation, during nerve decompression and wound closure and at the time of discharge. The interpeak latency of waves I-V and the wave V amplitude during nerve decompression or wound closure were compared with those on admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Secretion of tears in patients with hemifacial spasm.

Hemifacial spasm can cause abnormal tear secretion on the affected side. Thirty patients with this disease were examined using the Schirmer's test without topical anesthetic. Twelve of them showed more tear secretion on the affected side than on the unaffected side. The average Schirmer test value was 30.4 +/- 12.3 mm (+/- SD) on the affected side in the patients and 17.4 +/- 10.9 mm (n = 148) in the control subjects (P less than 0.001). Microvascular decompression surgery reduced the hypersecretion of tears. The results suggest that compression of the facial nerve by a blood vessel causes an excitatory stimulus for tear secretion in patients with hemifacial spasm.

Adult↗
PubMed1990

[Disappearance of hemifacial spasm following spinal drainage: a case report].

This report is concerned with a case of right hemifacial spasm (HFS) occurring in a 65-year-old woman, who incidentally had a left internal carotid-ophthalmic artery aneurysm. The aneurysm was successfully treated by clipping its neck. However, spinal drainage had to be performed postoperatively in order to prevent possible cerebrospinal fluid (CSF) rhinorrhea, as the roof of the sphenoid sinus was accidentally opened during the aneurysm surgery. Liquorrhea was observed and stopped on the 5th postoperative day. The drain was then removed only to be reset because CSF rhinorrhea recurred 8 days later, when the HFS began to subside. When the spinal drain was finally removed 9 days later, the HFS was scarcely seen. The HFS was thought to be due to the compression of the right facial nerve by the ipsilateral AICA. The draining of the CSF might have changed the amount and flow of the liquor and consequently the positional relationship among the facial nerve, the AICA and the arachnoid membrane, resulting in neurovascular decompression.

Aged↗
PubMed1990

[Selective injury of the vestibular and facial nerves following microvascular decompression procedures for hemifacial spasm: A case report].

Microvascular decompression procedures were carried out to relieve right hemifacial spasm in a 54-year-old man. His facial spasm was satisfactorily cured but he complained of severe vertigo, and slight facial palsy was also shown after the operation. Electronystagmograph disclosed spontaneous horizontal and rotatory nystagmus toward the non-operated (left) side. The postoperative caloric test showed profound dysfunction on the operated side. His hearing was well maintained postoperatively. These findings indicated, in addition to facial nerve injury, that the peripheral portion of the vestibular nerve was selectively damaged by the operative manipulations. It was shown that both the facial and vestibular nerves tended to be injured when the nerve trunk was shifted caudal-to-rostrally due to manipulations in the CP angle. It was stressed that caution should be paid to preserve not only the cochlear but also the vestibular nerve function in cerebellopontine angle manipulations.

Arteries↗
PubMed1990

Grading facial nerve function: House-Brackmann versus Burres-Fisch methods.

Many systems for reporting results of facial function tests have been proposed, but after five International Facial Nerve Symposia, a perfect system for reporting has yet to be developed. In 1985 the American Academy of Otolaryngology-Head and Neck Surgery adopted the House-Brackmann (H-B) six-point subjective grading scale as a universal standard. This decision was based on the recommendation of the Facial Nerve Disorders Committee. The next year, 1986, Burres and Fisch proposed the Linear Measurement Index (B-F LMI) as an alternative, objective grading system. To determine the ability of each system to grade the facial function of patients with facial palsy, and the relative merits of each system, 41 patients with facial weakness and one normal patient were studied. The H-B grading system is easy to use and provides simple, concise criteria for each separate grade of facial function. The B-F LMI grading system is time-consuming and labor-intensive, and requires a complex calculation to derive a percentage value that represents facial function. The most important finding of this study was the high degree of correlation between the two systems, in spite of the fact that the H-B system is subjective and qualitative while the B-F LMI system is objective and quantitative. Until the perfect grading system is developed, the authors favor combining the H-B and B-F LMI systems as the best method available at the moment to evaluate facial function.

Facial Injuries↗
PubMed1989

[Facial nerve].

Explore the source record for details and available documents.

Facial Muscles↗
PubMed1989

[Detection and stimulus-detection electromyography (EMG), blink-reflex and trigeminal (V2 and V3) somatosensory evoked potentials (SSEP) in peripheral facial paralyses induced by cold. Importance of the systematic use of V SSEP in facial paralyses induced by cold].

Thirty-six patients afflicted with cold-induced peripheral facial paralysis were examined by classical detection and stimulus-detection E.M.G. methods (Blink Reflex) complemented by V (V2, V3) S.E.P. These examinations were carried out 4 to 7 weeks after the deficiency set in. Detection and stimulus-detection E.M.G. is the best method of confirming clinical diagnosis of peripheral facial paralysis. If there is the slightest sign of Charles Bell, the Blink-Reflex is an excellent confirmation test. S.E.P. of the V allows infra-clinical damage to the nerve to be discerned in 45% of the cases. The cause of this damage is a subject of debate.

Blinking↗
PubMed1989

Bell's palsy: management of sequelae using EMG rehabilitation, botulinum toxin, and surgery.

Fifteen percent of patients who have had an acute episode of Bell's palsy will be left with debilitating facial dysfunction. This chapter describes our approach to managing a variety of hypo- and hyperkinetic disorders caused by injury and faulty regeneration of the facial nerve, using electromyographic rehabilitation (EMGR) (13 patients), Oculinum toxin injection (14 patients), or surgical reanimation (72 patients). Improvement was noted after EMGR in 12 of 13 patients (92%), all 14 patients treated with Oculinum experienced temporary improvement, and improvement was noted in 66 of 72 patients who underwent surgery (92%). The indications, techniques, and results of these three rehabilitative methods are discussed.

Biofeedback, Psychology↗
PubMed1989

[A case of multiple sclerosis with high CSF antibody titer to HTLV-I].

A case of multiple sclerosis (MS) in a 39 year old Japanese female with high antibody titer to human T-lymphotropic virus type I (HTLV-I) in serum and cerebrospinal fluid (CSF) was reported. At the age of 15, gait and urinary disturbances accompanied by sensory impairment in the lower abdomen and lower extremities developed suddenly. The motor disturbance slowly progressed to tetraparesis over a period of 15 years with several remissions. At the age of 28 the patient suffered from an acute loss of visual acuity, unilateral initially, and became blind by the age of 34. On admission to our department in September, 1987, the patient was alert and had spastic paraparesis, the impairment of all sensory modalities below the level of Th 10 and urinary disturbance. Weakness of facial muscles, nystagmus, deviation of the tongue and dysarthria were also noted. By the PA method, the antibody titer to HTLV-I was measured x512 in the serum and x64 in the CSF. Western blotting analysis of the CSF disclosed the bands to p19, p24 and p28 of HTLV-I gag proteins. The CSF contained a few ATL-like atypical cells and showed mild lymphocytosis, but the total protein was not increased. The computed tomography revealed diffuse low density areas in the cerebral white matter. The magnetic resonance imaging disclosed high intensity signal areas in the cerebral white matter and in the dorsolateral portion of the medulla oblongata on the T2 weighted image. The link of HTLV-I infection to the pathogenesis of human demyelinating diseases was discussed.

Adult↗
PubMedDate not supplied

[Writer's cramp syndrome treated successfully by thalamotomy].

In the literature the prevalent until now opinion was that writer's cramp was a disturbance of psychic origin or an occupational neurosis. However, the authors treated successfully three cases of this syndrome with thalamotomy in the years 1976-1982. Two cases were in subject with right-handedness who had graphospasm with evidence of increasing difficulty in writing until complete impossibility of further writing, after several years postural and intentional tremor appeared, and dystonic symptoms developed in the right foot. The third cases had a history of 16 years of writer's cramp and after years symptoms of right-sided dystonia with involuntary movements of the right upper extremity and continuous tics and spams of the facial muscles. After thalamotomy in all cases writer's cramp, tremors and involuntary movements disappeared, writing became again possible and the efficiency of right extremities returned. The described cases of writer's clamp were focal forms of dystonia which became generalized after years. The indications to stereotaxic treatment in these syndromes should be established much earlier.

Adult↗