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Dolichoectatic arteries are elongated tortuous aneurysms of intracranial arteries most commonly of vertebrobasilar tree presenting with ischaemic, haemorrhagic, thromboembolic lesions or with cranial nerve compression. The clinical presentation includes tic douloureux, neuralgia, tinnitus, vertigo, motor or sensory deficits, ataxia, dementia, Parki...
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Context 1
... patient had no history of diabetes or tobacco smoking but was a known chronic hypertensive. The patient complained of recurrent and alternating facial hemiparesis on either side since 1975 (table 1). The patient presented to us with facial heaviness of 6 days followed by deviation of angle of mouth to the right side along with drooling of saliva from left corner of mouth and sticking of food in the left side of the cheek for the next 3 days. ...Context 2
... patient had no history of diabetes or tobacco smoking but was a known chronic hypertensive. The patient complained of recurrent and alternating facial hemiparesis on either side since 1975 (table 1). The patient presented to us with facial heaviness of 6 days followed by deviation of angle of mouth to the right side along with drooling of saliva from left corner of mouth and sticking of food in the left side of the cheek for the next 3 days. ...Citations
Objective:
To investigate the surgical outcomes in patients treated for recurrent facial nerve palsy (RFP) at a quaternary facial nerve referral center.
Methods:
A retrospective chart review was performed on 132 patients with RFP who presented to our institution's facial nerve clinic from 2001 to 2021. Records were analyzed for etiology of palsy, facial nerve function, and recurrence rates. Pre- and post-operative audiometric outcomes were also assessed in surgically managed patients.
Results:
6.8% of RFP patients underwent surgical decompression. For patients who did not undergo surgery, the House-Brackmann (HB) score was 2.9 ± 1.3 (SD) at the initial clinic visit, and 2.4 ± 1.3 (SD) at the last clinic visit. This difference was significantly different (p = 0.01, t-test). For surgical patients, the pre-operative HB score was 2.9 ± 0.9 (SD) and post-operative HB score was 1.8 ± 0.6 (SD), which were significantly different (p = 0.01, t-test). The number of facial palsy episodes also decreased pre- and post-operatively from 3.5 ± 0.8 (SD) to 0.2 ± 0.4 (SD) episodes, which were significantly different (p < 0,001, t-test). Audiometric outcomes were not significantly different pre- and post-surgery (p = 0.31, t-test for PTA; p = 0.34, t-test for WRS).
Conclusion:
Facial nerve decompression for RFP patients with incomplete functional recovery may be an effective treatment for decreasing the frequency and severity of facial palsy episodes.
Level of evidence:
4 Laryngoscope, 133:1222-1227, 2023.
Vertebrobasilar dolichoectasia (VBD) is a rare arteriopathy defined as expansion, elongation, and/or increased tortuosity of the vertebrobasilar arteries. This disease has a complex and, as yet, incompletely described pathophysiology. Hypertension and atherosclerotic changes, congenital abnormalities, and upregulation of certain matrix metalloproteinases are associated with an increased incidence of VBD. Common to all VBD patients is disruption of the internal elastic lamina of the dolichoectatic vessel (1). VBD is more common in males and is overwhelmingly seen in patients older than 50, unless a congenital etiology is present (1). Radiographically, VBD is diagnosed using Smoker's criteria which include: 1) vertebrobasilar artery diameter more than 4.5 mm, 2) deviation of any point of the artery more than 10 mm from its expected course, and 3) length of basilar artery more than 29.5 mm or length of the intracranial vertebral artery more than 23.5 mm (2,3).
Patients with VBD may present with a variety of associated conditions including ischemic stroke, intracranial hemorrhage, brainstem compression, and hydrocephalus (1). Cranial nerve compression due to VBD has been described. These patients may present with refractory trigeminal neuralgia, hemifacial spasm, tinnitus, hoarseness, or dysphagia (1). Microvascular decompression of the dolichoectatic artery has been demonstrated to improve symptoms in patients experiencing trigeminal neuralgia and hemifacial spasm secondary to VBD (1,4).
To our knowledge, there are no previous reports of symptomatic VBD compression of cranial nerve VIII (CNVIII).
