A New Management Strategy for Hemimasticatory Spasm

Zhongding Zhang; Datan Lu; Tingting Ying; Shiting Li; Hua Zhao

doi:10.1055/a-2479-5625

Journal of Neurological Surgery Part A: Central European Neurosurgery, Inhaltsverzeichnis

J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2479-5625

Original Article

A New Management Strategy for Hemimasticatory Spasm

Zhongding Zhang^*

¹Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Yangpu District, Shanghai, People's Republic of China

,

Datan Lu^*

²Department of Neurology, Longling County People's Hospital, Baoshan City, China

,

Tingting Ying

¹Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Yangpu District, Shanghai, People's Republic of China

,

Shiting Li

¹Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Yangpu District, Shanghai, People's Republic of China

,

Hua Zhao

¹Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Yangpu District, Shanghai, People's Republic of China

› Institutsangaben

Abstract

Background Hemimasticatory spasm (HMS) is an uncommon movement disorder of the trigeminal motor rootlet characterized by unilateral, involuntary, and paroxysmal contractions of the muscles of mastication. The mechanisms for HMS are still unclear, and an efficient treatment strategy still needs to be developed. This study aims to investigate the clinical features and surgical treatment of HMS.

Methods Twelve patients with HMS were included in our study. The patient data regarding clinical characteristics, neuroimaging presentations, intraoperative findings, and treatment outcomes were analyzed retrospectively. Highly selective trigeminal motor root rhizotomy (HSTR) combined with microvascular compression was performed in nine cases with neurovascular conflict, whereas three patients without vascular compression underwent HSTR only.

Results Intraoperative findings showed that there were two patients with six branches, two patients with five branches, and the remaining patients with three to four branches of the trigeminal motor roots. Seven patients had two motor branches severed, three patients had one motor branch severed, and two patients each had three motor branches severed. Nine patients recovered uneventfully and showed no signs of spasms, and the remaining two patients experienced complete disappearance of symptoms within 3 months after surgery. In one patient, the symptoms disappeared immediately after surgery but recurred 2 years later.

Conclusion The surgical procedures of HSTR can significantly alleviate the clinical symptoms of patients with HMS without serious complications.

Keywords

hemimasticatory spasm - rhizotomy - microvascular compression

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Referenzen

References
1 Yoshida K. Hemimasticatory spasm: a series of 17 cases and a comprehensive review of the literature. Front Neurol 2024; 15: 1377289
2 Xu H, Xu B, Huang X, Zhang D, Cai X. Treatment of hemimasticatory spasm secondary to Parry-Romberg syndrome via partial resection of the trigeminal nerve motor branch under intraoperative neurophysiological monitoring: a case report and literature review. Front Surg 2023; 10: 1146163
3 Thompson PD, Carroll WM. Hemimasticatory spasm–a peripheral paroxysmal cranial neuropathy?. J Neurol Neurosurg Psychiatry 1983; 46 (03) 274-276
4 Cruccu G, Inghilleri M, Berardelli A. et al. Pathophysiology of hemimasticatory spasm. J Neurol Neurosurg Psychiatry 1994; 57 (01) 43-50
5 Teive HA, Piovesan EJ, Germiniani FM. et al. Hemimasticatory spasm treated with botulinum toxin: case report. Arq Neuropsiquiatr 2002; 60 (2-A): 288-289
6 Wang YN, Dou NN, Zhou QM. et al. Treatment of hemimasticatory spasm with microvascular decompression. J Craniofac Surg 2013; 24 (05) 1753-1755
7 Dou NN, Zhong J, Zhou QM, Zhu J, Wang YN, Li ST. Microvascular decompression of trigeminal nerve root for treatment of a patient with hemimasticatory spasm. J Craniofac Surg 2014; 25 (03) 916-918
8 Sun H, Wei Z, Wang Y, Liu C, Chen M, Diao Y. Microvascular decompression for hemimasticatory spasm: a case report and review of the literature. World Neurosurg 2016; 90: 703.e5-703.e10
9 Chen L, Wu G, Wang H, Guo X, Chitkara N. Hemimasticatory spasm: does microvascular decompression of trigeminal motor root work?. Neurol India 2021; 69 (03) 757-758
10 Li Q, Wang X, Wang L, Chen G. Surgical treatment strategies for hemimasticatory spasms. Chin Med J (Engl) 2022; 135 (09) 1105-1107
11 Gunduz A, Karaali-Savrun F, Uluduz D. Hemimasticatory spasm following pontine infarction. Mov Disord 2007; 22 (11) 1674-1675
12 Auger RG, Litchy WJ, Cascino TL, Ahlskog JE. Hemimasticatory spasm: clinical and electrophysiologic observations. Neurology 1992; 42 (12) 2263-2266
13 Kim JH, Han SW, Kim YJ. et al. A case of painful hemimasticatory spasm with masseter muscle hypertrophy responsive to botulinum toxin. J Mov Disord 2009; 2 (02) 95-97
14 Sinha R, Chattopadhyay PK, Roychowdhury SK, Bennur S. Hemimasticatory spasm: a case report with a new management strategy. J Maxillofac Oral Surg 2011; 10 (02) 170-172
15 Chon KH, Lee JM, Koh EJ, Choi HY. Hemimasticatory spasm treated with microvascular decompression of the trigeminal nerve. Acta Neurochir (Wien) 2012; 154 (09) 1635-1639
16 Yan KK, Wei JB, Lin W, Zhang YH, Zhang M, Li M. Hemimasticatory spasm with a single venous compression treated with microvascular decompression of the trigeminal motor rootlet. World Neurosurg 2017; 104: 1050.e19-1050.e22