title: Microvascular decompression for the patient with painful tic convulsif after Bell palsy.
abstract: Painful tic convulsif is referred to as the concurrent trigeminal neuralgia and hemifacial spasm. However, painful tic convulsif after ipsilateral Bell palsy has never been reported before. We report a case of a 77-year-old woman with coexistent trigeminal neuralgia and hemifacial spasm who had experienced Bell palsy half a year ago. The patient underwent microvascular decompression. Intraoperatively, the vertebrobasilar artery was found to deviate to the symptomatic side and a severe adhesion was observed in the cerebellopontine angle. Meanwhile, an ectatic anterior inferior cerebellar artery and 2 branches of the superior cerebellar artery were identified to compress the caudal root entry zone (REZ) of the VII nerve and the rostroventral cisternal portion of the V nerve, respectively. Postoperatively, the symptoms of spasm ceased immediately and the pain disappeared within 3 months. In this article, the pathogenesis of the patient's illness was discussed and it was assumed that the adhesions developed from inflammatory reactions after Bell palsy and the anatomic features of the patient were the factors that generated the disorder. Microvascular decompression surgery is the suggested treatment of the disease, and the dissection should be started from the caudal cranial nerves while performing the operation.
authors.affiliation: Department of Neurosurgery, Xinhua Hospital/The Cranial Nerve Disease Center of Shanghai, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiao
authors.forename: Jun
authors.initials: J
authors.lastname: Zhong
authors.forename: Hui
authors.initials: H
authors.lastname: Sun
authors.forename: Jin
authors.initials: J
authors.lastname: Zhu
authors.forename: Qiu-Meng
authors.initials: QM
authors.lastname: Zhou
authors.forename: Xiao-Sheng
authors.initials: XS
authors.lastname: Yang
authors.forename: Shi-Ting
authors.initials: ST
authors.lastname: Li
mesh_terms: D000368:Aged; D001488:Basilar Artery / Q000002:abnormalities / Q000601:surgery; D020330:Bell Palsy / Q000150:complications*; D002526:Cerebellar Diseases / Q000209:etiology / Q000601:surgery; D002530:Cerebellopontine Angle / Q000473:pathology; D002531:Cerebellum / Q000098:blood supply; D019299:Decompression, Surgical / Q000379:methods*; D005155:Facial Nerve Diseases / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D019569:Hemifacial Spasm / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000601:surgery; D013684:Telangiectasis / Q000150:complications; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery; D020433:Trigeminal Nerve Diseases / Q000209:etiology / Q000601:surgery; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000601:surgery*; D014711:Vertebral Artery / Q000002:abnormalities / Q000601:surgery; D000160:Vestibulocochlear Nerve Diseases / Q000209:etiology / Q000601:surgery