Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Delayed Unilateral Soft Palate Palsy without Vocal Cord Involvement after Microvascular Decompression for Hemifacial Spasm

  • Park, Jae Han (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jo, Kyung Il (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Kwan (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2013.01.02
  • Accepted : 2013.06.19
  • Published : 2013.06.28
Download PDF
⟨ Previous Next ⟩

Abstract

Microvascular decompression is a very effective and relatively safe surgical modality in the treatment of hemifacial spasm. But rare debilitating complications have been reported such as cranial nerve dysfunctions. We have experienced a very rare case of unilateral soft palate palsy without the involvement of vocal cord following microvascular decompression. A 33-year-old female presented to our out-patient clinic with a history of left hemifacial spasm for 5 years. On postoperative 5th day, patient started to exhibit hoarsness with swallowing difficulty. Symptoms persisted despite rehabilitation. Various laboratory work up with magnetic resonance image showed no abnormal lesions. Two years after surgery patient showed complete recovery of unitaleral soft palate palsy. Various etiologies of unilateral soft palate palsy are reviewed as the treatment and prognosis differs greatly on the cause. Although rare, it is important to keep in mind that such complication could occur after microvascular decompression.

Keywords

References

  1. Cohen-Gadol AA : Microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm : naunces of the technique based on experiences with 100 patients and review of the literature. Clin Neurol Neurosurg 113 : 844-853, 2011 https://doi.org/10.1016/j.clineuro.2011.06.003
  2. Erman AB, Kejner AE, Hogikyan ND, Feldman EL : Disorders of cranial nerves IX and X. Semin Neurol 29 : 85-92, 2009 https://doi.org/10.1055/s-0028-1124027
  3. Fang TJ, Tam YY, Courey MS, Li HY, Chiang HC : Unilateral high vagal paralysis : relationship of the severity of swallowing disturbance and types of injuries. Laryngoscope 121 : 245-249, 2011 https://doi.org/10.1002/lary.21342
  4. Gillig PM, Sanders RD : Cranial Nerves IX, X, XI, and XII. Psychiatry (Edgmont) 7 : 37-41, 2010
  5. Jeon CJ, Kong DS, Lee JA, Park K : The efficacy and safety of microvascular decompression for hemifacial spasm in elderly patients. J Korean Neurosurg Soc 47 : 442-445, 2010 https://doi.org/10.3340/jkns.2010.47.6.442
  6. Lapresle J, Faux N : [Unilateral involvement of IX, X, Xi and XII in cervical zoster. Cranial nerve contribution to vascular pathology]. J Neurol Sci 52 : 351-357, 1981 https://doi.org/10.1016/0022-510X(81)90016-2
  7. Lapresle J, Lasjaunias P, Thévenier D : [Transitory paralysis of cranial nerves IX, X and XII as well as the left VII after angiography. Contribution to the ischemic pathology of the cranial nerves]. Rev Neurol (Paris) 136 : 787-791, 1980
  8. Nusbaum AO, Som PM, Dubois P, Silvers AR : Isolated vagal nerve palsy associated with a dissection of the extracranial internal carotid artery. AJNR Am J Neuroradiol 19 : 1845-1847, 1998
  9. Paniello RC, Edgar JD, Kallogjeri D, Piccirillo JF : Medialization versus reinnervation for unilateral vocal fold paralysis : a multicenter randomized clinical trial. Laryngoscope 121 : 2172-2179, 2011 https://doi.org/10.1002/lary.21754
  10. Resnick DK, Jannetta PJ : Hyperactive rhizopathy of the vagus nerve and microvascular decompression. Case report. J Neurosurg 90 : 580-582, 1999 https://doi.org/10.3171/jns.1999.90.3.0580
  11. Rhee DJ, Kong DS, Park K, Lee JA : Frequency and prognosis of delayed facial palsy after microvascular decompression for hemifacial spasm. Acta Neurochir (Wien) 148 : 839-843; discussion 843, 2006 https://doi.org/10.1007/s00701-006-0847-9
  12. Tang SC, Jeng JS, Liu HM, Yip PK : Isolated vagus nerve palsy probably associated with herpes simplex virus infection. Acta Neurol Scand 104 : 174-177, 2001 https://doi.org/10.1034/j.1600-0404.2001.00021.x
  13. Thakar A, Sikka K, Verma R, Preetam C : Cricothyroid approximation for voice and swallowing rehabilitation of high vagal paralysis secondary to skull base neoplasms. Eur Arch Otorhinolaryngol 268 : 1611-1616, 2011 https://doi.org/10.1007/s00405-011-1614-y
  14. Tubbs RS, Mortazavi MM, Loukas M, Shoja MM, Cohen-Gadol AA : Intraoperative and anatomical descriptions of intracranial connections between the glossopharyngeal and vagus nerves : clinical implications. J Neurosurg 115 : 179-181, 2011 https://doi.org/10.3171/2011.2.JNS101757

Cited by

  1. Significance of Arachnoid Dissection to Obtain Optimal Exposure of Lower Cranial Nerves and the Facial Nerve Root Exit Zone during Microvascular Decompression Surgery vol.55, pp.1, 2013, https://doi.org/10.3340/jkns.2014.55.1.64
  2. Delayed hearing loss after microvascular decompression for hemifacial spasm vol.161, pp.3, 2013, https://doi.org/10.1007/s00701-018-3774-7