Intermediate nerve neuralgia developed during hemifacial spasm follow-up: illustrative case.
3DMRC/MRA = three-dimensional magnetic resonance cisternogram/magnetic resonance angiogram
AICA = anterior inferior cerebellar artery
CN = cranial nerve
HFS = hemifacial spasm
INN = intermediate nerve neuralgia
MVD = microvascular decompression
PICA = posterior inferior cerebellar artery
REZ = root exit zone
TN = trigeminal neuralgia
hemifacial spasm
intermediate nerve neuralgia
microvascular decompression
Journal
Journal of neurosurgery. Case lessons
ISSN: 2694-1902
Titre abrégé: J Neurosurg Case Lessons
Pays: United States
ID NLM: 9918227275606676
Informations de publication
Date de publication:
20 Jun 2022
20 Jun 2022
Historique:
received:
23
03
2022
accepted:
06
04
2022
entrez:
23
6
2022
pubmed:
24
6
2022
medline:
24
6
2022
Statut:
epublish
Résumé
Intermediate nerve neuralgia (INN) is a rare condition believed to be caused by vascular compression, with external auditory canal pain as the chief symptom. The authors reported a rare case of a 78-year-old woman who developed INN during follow-up for hemifacial spasm (HFS). The patient had been receiving Botox treatment for right HFS for 20 years when she developed paroxysmal electric shock pain in the right external auditory canal and tinnitus induced by opening her mouth. A three-dimensional magnetic resonance fusion image showed the cisternal portion of the facial-vestibulocochlear nerve complex to be compressed by the meatal loop of the anterior inferior cerebellar artery (AICA), which was pressed against by the posterior inferior cerebellar artery. The authors diagnosed INN, and microvascular decompression (MVD) was performed. Surgical findings were consistent with preoperative neuroimaging. In addition, the proximal portion of the meatal loop of the AICA had passed between the facial and vestibulocochlear nerves, compressing both. The AICA was moved and the nerve completely decompressed. All symptoms improved immediately following surgery. When INN occurs during HFS follow-up, aggressive MVD should be considered based on detailed neuroimaging. This treatment is a very effective single-stage cure for INN, HFS, and vestibulocochlear symptoms.
Sections du résumé
BACKGROUND
BACKGROUND
Intermediate nerve neuralgia (INN) is a rare condition believed to be caused by vascular compression, with external auditory canal pain as the chief symptom. The authors reported a rare case of a 78-year-old woman who developed INN during follow-up for hemifacial spasm (HFS).
OBSERVATIONS
METHODS
The patient had been receiving Botox treatment for right HFS for 20 years when she developed paroxysmal electric shock pain in the right external auditory canal and tinnitus induced by opening her mouth. A three-dimensional magnetic resonance fusion image showed the cisternal portion of the facial-vestibulocochlear nerve complex to be compressed by the meatal loop of the anterior inferior cerebellar artery (AICA), which was pressed against by the posterior inferior cerebellar artery. The authors diagnosed INN, and microvascular decompression (MVD) was performed. Surgical findings were consistent with preoperative neuroimaging. In addition, the proximal portion of the meatal loop of the AICA had passed between the facial and vestibulocochlear nerves, compressing both. The AICA was moved and the nerve completely decompressed. All symptoms improved immediately following surgery.
LESSONS
CONCLUSIONS
When INN occurs during HFS follow-up, aggressive MVD should be considered based on detailed neuroimaging. This treatment is a very effective single-stage cure for INN, HFS, and vestibulocochlear symptoms.
Identifiants
pubmed: 35733844
doi: 10.3171/CASE22144
pii: CASE22144
pmc: PMC9210264
doi:
Types de publication
Case Reports
Langues
eng
Pagination
CASE22144Informations de copyright
© 2022 The authors.
Déclaration de conflit d'intérêts
Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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