Skip to main content
Log in

The cranial nerve vascular compression syndrome: II. A review of pathophysiology

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

The various hypotheses regarding the pathophysiologies of trigeminal neuralgia and hemifacial spasm are reviewed, and the results of recent physiological studies on the pathogenesis of hemifacial spasm are discussed. Evidence is presented that strongly supports the hypothesis that the symptoms and signs of hemifacial spasm are caused by hyperactivity in the facial motonucleus. Some of the contradictions regarding the prevalence of vascular conflicts in the cerebellopontine angle and the symptoms of vascular compression are discussed, and a hypothesis is presented that assumes that a suitable substrate must be present, in addition to vascular compression of the respective cranial nerve root, for the symptoms and signs of a cranial nerve vascular compression disorder to develop. Finally, it is discussed how this hypothesis can explain some of the differences between the disorders that can be cured by microvascular deompression of respective cranial nerves.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adams CBT (1989) Microvascular compression: An alternative view and hypothesis. J Neurosurg 57: 1–12

    Google Scholar 

  2. Auger RG, Piepgras DG, Laws Jr ER, Miller RH (1981) Microvascular decompression of the facial nerve for hemifacial spasm: Clinical and electrophysiologic observations. Neurology 31: 346–350

    PubMed  Google Scholar 

  3. Bertrand RA, Molina P, Hardy J (1977) Vestibular syndrome and vascular anomaly in the cerebello-pontine angle. Acta Otolaryngol (Stockh) 83: 187–194

    Google Scholar 

  4. Burchiel KJ (1988) Carbamazepine inhibits spontaneous activity in experimental neuromas. Exp Neurol 102: 249–253

    PubMed  Google Scholar 

  5. Calvin WH, Loeser JD, Howe JF (1977) A neurophysiological theory for the pain mechanism of tic douloureux. Pain 3: 147–154

    PubMed  Google Scholar 

  6. Digre K, Corbett JJ (1988) Hemifacial spasm: Differential diagnosis mechanism and treatment. In: Tolosa E (ed) Advances in neurology, Vol. 39. Facial Dyskinesia. Raven Press, New York, pp 151–176

    Google Scholar 

  7. Esslen E (1957) Der Spasmus facialis eine Parabiosserscheinung: Elektrophysiologische Untersuchungen zum Entstehungsmechanismus des Facialisspasmus. Dtsch Z Nervenheil 176: 149–172

    Google Scholar 

  8. Esteban A, Molina-Negro P (1986) Primary hemifacial spasm: A neurophysiological study. J Neurol Neurosurg Psychiatry 49: 58–63

    PubMed  Google Scholar 

  9. Ferguson JH (1978) Hemifacial spasm and the facial nucleus. Ann Neurol 4: 97–103

    PubMed  Google Scholar 

  10. Fromm GH (1985) Effects of different classes of antiepileptic drugs on brainstem pathways. Fed Proc 44: 2432–2435

    PubMed  Google Scholar 

  11. Fromm GH (1991) Pathophysiology of trigeminal neuralgia. In: Fromm GH, Sessle BJ (eds) Trigeminal neuralgia. Butterworth Heineman, Boston

    Google Scholar 

  12. Fromm GH, Chattha AS, Terrence CF, Class JD (1981) Role of inhibitory mechanism in trigeminal neuralgia. Neurology 31: 683–687

    PubMed  Google Scholar 

  13. Gardner WJ (1962) Concerning the mechanism of trigeminal neuralgia and hemifacial spasm. J Neurosurg 19: 947–958

    PubMed  Google Scholar 

  14. Gardner WJ, Sava GA (1962) Hemifacial spasm—a reversible pathophysiologic state. J Neurosurg 19: 240–247

    Google Scholar 

  15. Graeber MB, Kreutzberg GW (1988) Delayed astrocyte reaction following facial nerve axotomy. J Neurocytology 17: 209–220

    Google Scholar 

  16. Granit R, Skoglund CR, Leskell L (1944) Fiber interaction in injured or compressed region of nerve. Brain 67: 125–140

    Google Scholar 

  17. Hardy DG, Rhoton AL Jr (1978) Microsurgical relationship of the superior cerebellar artery and the trigeminal nerve. J Neurosurg 49: 669–678

    PubMed  Google Scholar 

  18. Howe JF, Loeser JD, Calvin WH (1977) Mechanosensitivity of dorsal root ganglia and chronically injured axons: A physiological basis for the radicular pains of root compression. Pain 3: 25–41

    PubMed  Google Scholar 

  19. Itagaki S, Saito S, Nakai O (1988) Intraoperative recording of evoked EMG in patients with hemifacial spasm-possible physiological mechanism. Facial N Res Jpn 8: 143–146

    Google Scholar 

  20. Itagaki S, Saito S, Nakai O (1989) Electrophysiological study on hemifacial spasm-usefulness in etiological diagnosis and pathophysiological mechanism. Brain and Nerve (Tokyo) 41: 1005–1011

    Google Scholar 

  21. Jannetta PJ, Hackett ER, Ruby JR (1970) Electromyographic and electron microscopic correlates in hemifacial spasm, treated by microsurgical relief of neurovascular compression. Surg Forum 21: 449–451

    PubMed  Google Scholar 

  22. Kerr FWL, Miller RH (1966) The pathology of trigeminal neuralgia. Arch Neurol 15: 308–319

    PubMed  Google Scholar 

  23. Kim P, Fukushima T (1984) Observations on synkinesis in patients with hemifacial spasm. J Neurosurg 60: 821–827

    PubMed  Google Scholar 

  24. Kimura J (1983) Clinical uses of the electrically elicited blink reflex. In: Desmedt JE (eds) Motor control mechanisms in health and disease: new developments and clinical applications. Raven Press, New York, pp 773–786

    Google Scholar 

  25. Kugelberg E (1952) Facial reflexes. Brain 75: 385–396

    PubMed  Google Scholar 

  26. Kumagami H (1974) Neuropathological findings of hemifacial spasm and trigeminal neuralgia. Arch Otolaryngol 99: 160–164

    PubMed  Google Scholar 

  27. Matsushima T, Inoue T, Fukui M (1990) Arteries in contact with the cisternal portion of the facial nerve in autopsy cases: Microsurgical anatomy for neurovascular decompression surgery of hemifacial spasm. Surg Neurol 34: 87–93

    PubMed  Google Scholar 

  28. Melita A, Trontelj J, Trontelj JV (1978) Reflex arc of the firt component of the human blink reflex: A single motoneurone study. J Neurol Neurosurg Psychiatry 41: 538–547

    PubMed  Google Scholar 

  29. Møller AR (1987) Hemifacial spasm: Ephaptic transmission or hyperexcitability of the facial motor nucleus? Exp Neurol 98: 110–119

    PubMed  Google Scholar 

  30. Møller AR (1991) Interaction between the blink reflex and abnormal muscle response in patients with hemifacial spasm: Results of intraoperative recordings. J Neurol Sci 101: 114–123

    PubMed  Google Scholar 

  31. Møller MB (1990) Disabling positional vertigo. In: Myers EN, Bluestone CD, Brackmann DE, Krause CJ (eds) Advances in otolaryngology—head and neck surgery, Vol. 4. Mosby Year Book, Inc, Chicago, pp 81–106

    Google Scholar 

  32. Møller AR, Jannetta PJ (1984) On the origin of synkinesis in hemifacial spasm: Results of intracranial recordings. J Neurosurg 61: 569–576

    PubMed  Google Scholar 

  33. Møller AR, Jannetta PJ (1985 a) Synkinesis in hemifacial spasm: Results of recording intracranially form the facial nerve. Experientia 41: 415–417

    PubMed  Google Scholar 

  34. Møller AR, Jannetta PJ (1985 b) Microvascular decompression in hemifacial spasm: Intraoperative electrophysiological observations. Neurosurgery 16: 612–618

    Google Scholar 

  35. Møller AR, Jannetta PJ (1986 a) Blink reflex in patients with hemifacial spasm: Observations during microvascular decompression operations. J Neurol Sci 72: 171–182

    PubMed  Google Scholar 

  36. Møller AR, Jannetta PJ (1986 b) Physiological abnormalities in hemifacial spasm studied during microvascular decompression operations. Exp Neurol 93: 584–600

    PubMed  Google Scholar 

  37. Møller AR, Sen CN (1990) Recordings from the facial nucleus in the rat: Signs of abnormal facial muscle response. Exp Brain Res 91: 18–24

    Google Scholar 

  38. Møller MB, Møller AR (1985) Audiometric abnormalities in hemifacial spasm. Audiology 24: 396–405

    PubMed  Google Scholar 

  39. Møller MB, Møller AR, Jannetta PJ, Sekhar LN (1986) Diagnosis and surgical treatment of disabling positional vertigo. J Neurosurg 64: 21–28

    PubMed  Google Scholar 

  40. Moses H, Alexander GE (1982) Carbamazepine for hemifacial spasm. Neurology 32: 286–287

    PubMed  Google Scholar 

  41. Nielsen VK (1984 a) Pathophysiological aspects of hemifacial spasm. Part I. Evidence of ectopic excitation and ephaptic transmission. Neurology 34: 418–426

    PubMed  Google Scholar 

  42. Nielsen VK (1984 b) Pathophysiological aspects of hemifacial spasm. Part II. Lateral spread of the supraorbital nerve reflex. Neurology 34: 427–431

    PubMed  Google Scholar 

  43. Nielsen VK, Jannetta PJ (1984) Pathophysiological aspects of hemifacial spasm. Part III. Effects of facial nerve decompression. Neurology 36: 891–897

    Google Scholar 

  44. Odkvist LM, Thell J, von Essen C (1988) Vestibulooculomotor disturbances in trigeminal neuralgia and hemifacial spasm. Acta Otolaryngol (Stockh) 105: 570–575

    Google Scholar 

  45. Ouaknine GE (1981) Microsurgical anatomy of the arterial loops in the ponto-cerebellar angle and the internal acoustic meatus. In: Samii M, Jannetta PJ (eds) The cranial nerves. Springer, Berlin Heidelberg New York, pp 378–390

    Google Scholar 

  46. Rasminsky M (1980) Ephaptic transmission between single nerve fibers in the spinal nerve roots of dystrophic mice. J Physiol (Lond) 305: 151–169

    Google Scholar 

  47. Ravits J, Hallert M (1986) Pathophysiology of hemifacial spasm. Localization of the lesion in hemifacial spasm. Letter to the Editor. Neurology 36: 591

    PubMed  Google Scholar 

  48. Roth G, Magistris MR, Pinelli P, Rilliet B (1990) Cryptogenic hemifacial spasm. A neurophysiological study. Electromyogr Clin Neurophysiol 30: 361–370

    PubMed  Google Scholar 

  49. Ruby JR, Jannetta PJ (1975) Hemifacial spasm: Ultrastructural changes in the facial nerve induced by neurovascular compression. Surg Neurol 4: 369–370

    PubMed  Google Scholar 

  50. Saito S, Itagaki S, Nakai O (1990) Neurophysiological study on hemifacial spasm—the abnormality and origin of the electromyographic response to stimulation of the facial nerve. Brain and Nerve (Tokyo) 42: 621–627

    Google Scholar 

  51. Seltzer Z, Devor M (1979) Ephaptic transmission in chronically damaged peripheral nerves. Neurology 29: 1061–1064

    PubMed  Google Scholar 

  52. Sen CN, Møller AR (1987) Signs of hemifacial spasm created by chronic periodic stimulation of the facial nerve in the rat. Exp Neurol 98; 336–349

    PubMed  Google Scholar 

  53. Sunderland S (1948) Neurovascular relations and anomalies at the base of the brain. J Neurol Neurosurg Psychiatry 11: 243–257

    Google Scholar 

  54. Tanaka T, Yu H, Kitai ST (1971) Trigeminal and spinal inputs to the facial nucleus. Brain Res 33: 504–508

    PubMed  Google Scholar 

  55. Thompson PD, Carroll WM (1983) Hemimasticatory spasm—a peripheral paroxysmal cranial neuropathy. J Neurol Neurosurg Psychiatry 46: 274–276

    PubMed  Google Scholar 

  56. Valls-Sole J, Tolosa ES (1989) Blink reflex excitability cycle in hemifacial spasm. Neurology 39: 1061–1066

    PubMed  Google Scholar 

  57. Wall PD (1977) The presence of ineffective synapses and the circumstances which unmask them. Philos Trans R Soc Lond Biol 278: 361–1372

    PubMed  Google Scholar 

  58. Wartenberg R (1946) Associated movements in oculomotor and facial muscles. Arch Neurol Psychiatry 55: 439–488

    Google Scholar 

  59. Wartenberg R (1952) Hemifacial spasm. A clinical and pathophysiological study. University Park Press, New York

    Google Scholar 

  60. Williams HL, Lambert EH, Woltman HW (1952) The problem of synkinesis and contracture in cases of hemifacial spasm and Bell's palsy. Ann Otol Rhinol Laryngol 61: 850–870

    PubMed  Google Scholar 

  61. Woltman HW, Williams HL, Lambert EH (1951) An attempt to relieve hemifacial spasm by neurolysis of the facial nerves. Mayo Clin Proc 26: 236–240

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Møller, A.R. The cranial nerve vascular compression syndrome: II. A review of pathophysiology. Acta neurochir 113, 24–30 (1991). https://doi.org/10.1007/BF01402110

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01402110

Keywords

Navigation