Manejo microquirúrgico de hemiespasmo facial: reporte audiovisual de un caso

Abstract

Introduction: Facial hemispasm (FHS) is an unusual movement disorder characterized by involuntary contractions affecting the musculature innervated by the facial nerve, particularly on the upper hemi-face. Its prevalence is 9.8 per 100,000 inhabitants; however, it is underdiagnosed. Management includes medical treatment, botulinum toxin injection, and neurovascular decompression (NVD). Materials and Methods: This report presents the case of a 48-year-old female patient, M.D.Q, who consulted for unilateral involuntary contractions on the left hemi-face. Preoperative MRI showed neurovascular contact between the anterior cerebral artery and the facial vestibular complex from the trunk to distal. Surgical management was decided, involving a left retrosigmoid approach, dissecting the AICA and facial cochlear vestibular complex to release and separate the adhesions. The facial nerve was dissected, aiming to eliminate any existing adhesions from both arachnoid and blood vessels, ultimately generating a mechanical separation of the neurovascular complex, achieving a positive response to the lateral spread technique. An audiovisual analysis details the aforementioned preoperative findings, the microsurgery performed, intraoperative monitoring, and postoperative results. Results: Neurovascular decompression was effective and resolutive for the clinical management of the patient, with no postoperative complications reported. Discussion: Facial hemispasm is a disabling condition; medication treatment is minimally effective, and botulinum toxin therapy is effective but transient. Results: Neurovascular decompression is the treatment of choice because it is minimally invasive, reports better long-term results, and has a low complication rate. Conclusion: NVD is an effective and safe treatment in the hands of experienced neurosurgeons and allows for complete resolution of FHS in the majority of cases.