Intermediate nerve neuralgia developed during hemifacial spasm follow-up: illustrative case

Author:

Onoda Keisuke1,Sashida Ryohei1,Fujiwara Ren1,Wakamiya Tomihiro1,Michiwaki Yuhei1,Tanaka Tatsuya1,Shimoji Kazuaki1,Suehiro Eiichi1,Yamane Fumitaka1,Kawashima Masatou1,Matsuno Akira1

Affiliation:

1. Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Chiba, Japan

Abstract

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 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 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.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Management Science and Operations Research,Mechanical Engineering,Energy Engineering and Power Technology

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