Painful spasms in facial, masticatory, and motor ocular muscles reversed after microvascular decompression of a neurovascular conflict at brainstem
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The authors present a case of a 42-year-old female admitted for disabling complex and atypical bilateral facial spasms associated with painful masticatory and motor ocular dystonic movements, difficult to fit in the definition of any known cranio-facial dyskinesias. MRI showed a left PICA loop invaginated into the brainstem, considered responsible of an hyperactive disorder of the brainstem nuclei neighboring the conflict. After microvascular decompression, the patient made a full recovery with complete disappearance of the paroxystic phenomena. Such a type of image should be searched for, in an intra-axial brainstem location, in the absence of conflict in the cistern at root entry/exit zone (REZ).
KeywordsNeurovascular conflict Cranio-facial dyskinesia Hemi-facial spasm Micro-vascular decompression
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No funding was received for this research.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Ethical approval/informed consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The patient gave her informed consent for publication.
Part 1. Arachnoid dissection in order to obtain optimal exposure of lower cranial nerve complex and of the vestibulocochlear complex. Part 2. Dissection of the IXth and Xth cranial nerves allowing the exposure of the PICA loop. Part 3. Dissection between the rootlets of the lower cranial nerves followed be the extraction of the PICA loop deeply located into brainstem by inserting Teflon pads. (MP4 30,693 kb)
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