Surgical Management of Hemifacial Spasm Associated with Chiari I Malformation: Analysis of 28 Cases

Hemifacial Spasm Associated with Chiari Type I Malformation: Surgical Considerations and Case Report

“…The association between the 2 pathologies is rare, with just over 20 cases described so far in the literature. 3 The signs and symptoms of the disease are similar to those found in idiopathic HS with the upper part of the face predominantly involved during the initial stages, when CM I is asymptomatic. Strahle et al, 42 in 2011, reported that only 32% of patients with CM I detected in MRI were considered symptomatic during clinical diagnosis, indicating a high number of patients with pathology, but asymptomatic.…”

“…Subsequently, it is possible to consider neurovascular microdecompression of the facial nerve for patients who do not recover from facial spasm after decompression of the foramen magnum. 3,48,[50][51][52] Our patient was treated initially with facial nerve neurovascular microdecompression that led to the clinical resolution of HS. However, at the third postoperative day, her level of consciousness was lowered, she had speech difficulty and episodes of dyspnea/apnea.…”

“…Patients without significant CM I symptoms should be treated for HS with neurovascular microdecompression of the facial nerve. 3,49 On the other hand, patients with the two pathologies, with signs of craniovertebral instability, or clear symptoms of CM I, should be treated initially with foramen magnum decompression with or without craniovertebral fixation. 9,13,15 It is expected that the symptoms of the HS ameliorate after surgery for CM I in patients with the two pathologies.…”

“…1,2 Chiari malformation type I (CM I) is a congenital disease characterized by caudal migration of the cerebellar tonsils that causes disproportion between the contents and volume of the posterior fossa and compression of structures at the foramen magnum level. 3,4 Therefore, the decompression of foramen magnum structures is widely accepted as the treatment of choice for symptomatic CM I and can be performed using several techniques. [5][6][7][8] Hemifacial spasm associated with CM I is rare, with few cases reported in the literature.…”

“…The amelioration of HS symptoms seems to indicate a relationship between the geneses of the two pathologies. 3 Nevertheless, complications of posterior fossa surgery are rarely highlighted in the literature. Here, we report the case of a patient with HS associated with CM I without craniovertebral instability that was treated with posterior fossa decompression, drawing attention to the possible complications associated with this procedure and critically reviewing the factors that may influence possible surgical complications.…”