Hemilingual spasm: Defining a new entity, its electrophysiological correlates and surgical treatment through microvascular decompression

Leisha L. Osburn, Aage R. Møller, Jay Bhatt, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE: We report on vascular compression syndrome of the 12th cranial nerve (hypoglossal), an occurrence not previously reported, and demonstrate, through corresponding objective electrophysiological evidence, that microvascular decompression of the hypoglossal nerve root can cure hemilingual spasm. CLINICAL PRESENTATION: A 52-year-old man had lower face muscle twitching and tongue spasms, which worsened with talking, chewing, or emotional stress. Carbamazepine offered only temporary relief, and relief from injections of botulinum toxin was insignificant. He was referred for surgical treatment. High-resolution magnetic resonance imaging of his posterior fossa contents revealed no obvious evidence of any compressive vessel along the facial nerve, but a compressive vessel along the hypoglossal nerve was apparent. INTERVENTION: The presence of preoperative tongue spasms encouraged interoperative monitoring of tongue motor responses. The facial nerve exit zone was explored, but microsurgical inspection of the seventh/eighth cranial nerve complex did not reveal any compressive vessel. However, at the anterolateral aspect of the medulla oblongata, the hypoglossal nerve was clearly compressed and distorted laterally by a large tortuous vertebral artery. When the artery was mobilized away from the nerve, the abnormal late electromyographic response to transcranial electrical stimulation disappeared; immediately after shredded Teflon was interpositioned between the artery and the nerve, the abnormal spontaneous tongue fasciculation also disappeared. The patient has remained spasm free 6 months after surgery. CONCLUSION: Hemilingual spasm may be caused by vascular contact/compression along cranial nerve XII at the lower brainstem and belong to the same family of cranial nerve hyperactivity disorders as hemifacial spasm.

Original languageEnglish
Pages (from-to)192-195
Number of pages4
JournalNeurosurgery
Volume67
Issue number1
DOIs
StatePublished - Jul 2010

Fingerprint

Microvascular Decompression Surgery
Hypoglossal Nerve
Spasm
Facial Nerve
Tongue
Blood Vessels
Arteries
Vestibulocochlear Nerve
Hemifacial Spasm
Fasciculation
Therapeutics
Cranial Nerve Diseases
Medulla Oblongata
Botulinum Toxins
Vertebral Artery
Cranial Nerves
Mastication
Carbamazepine
Polytetrafluoroethylene
Psychological Stress

Keywords

  • Electrophysiology
  • Hemilingual spasm
  • Intraoperative neurophysiological monitoring
  • Microvascular decompression
  • Motor evoked potentials
  • Vascular compression

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Hemilingual spasm : Defining a new entity, its electrophysiological correlates and surgical treatment through microvascular decompression. / Osburn, Leisha L.; Møller, Aage R.; Bhatt, Jay; Cohen-Gadol, Aaron.

In: Neurosurgery, Vol. 67, No. 1, 07.2010, p. 192-195.

Research output: Contribution to journalArticle

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