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Table of Contents    
LETTERS TO EDITOR
Year : 2018  |  Volume : 66  |  Issue : 6  |  Page : 1826-1828

Cavernous angioma of the cerebellopontine angle presenting as hemifacial spasm


1 Department of Neurosurgery, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China
2 Department of Critical Care Medicine, Shengli Oilfield Central Hospital of Binzhou Medical University, Dongying, Shandong, China
3 Department of Neurology, Nanhai Hospital, Southern Medical University, Foshan, Guangdong, China

Date of Web Publication28-Nov-2018

Correspondence Address:
Dr. Jie Liu
Department of Critical Care Medicine, Shengli Oilfield Central Hospital of Binzhou Medical University, Shandong
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.246250

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How to cite this article:
Wang L, Jiang M, Yin H, Huang M, Zhu L, Liang X, Deng Y, Hu S, Zhang X, Liu J. Cavernous angioma of the cerebellopontine angle presenting as hemifacial spasm. Neurol India 2018;66:1826-8

How to cite this URL:
Wang L, Jiang M, Yin H, Huang M, Zhu L, Liang X, Deng Y, Hu S, Zhang X, Liu J. Cavernous angioma of the cerebellopontine angle presenting as hemifacial spasm. Neurol India [serial online] 2018 [cited 2018 Dec 10];66:1826-8. Available from: http://www.neurologyindia.com/text.asp?2018/66/6/1826/246250




Sir,

A 40-year old male worker with a history of hemifacial spasm of more than 10 years duration and presenting with severe persistent headache and aggravating right facial spasm, was sent to the emergency medical center of Shengli Oilfield Central Hospital. Emergency computed tomography showed a hematoma located in the right cerebellopontine angle area [Figure 1] and multiple irregular high-density shadows in the cerebrum [Figure 2]. He was subsequently admitted to the department of neurosurgery where a magnetic resonance imaging examination was performed to ascertain the cause of hemorrhage. Susceptibility-weighted imaging demonstrated multiple intracranial lesions with low signals, along with a low-signal hemosiderin ring around a high-signal popcorn ball-like appearance [Figure 3]. One of the lesions measuring 1.2 × 1.5 × 1.6 cm underwent hemorrhage in the cerebellopontine angle area [Figure 4]. In addition, contrast-enhanced magnetic resonance imaging and angiography displayed two high-signal, vascular lesions [Figure 5]. Surgical resection of the hemorrhagic lesion and removal of the intracranial hematoma were then performed through a right-sided retrosigmoid approach [Figure 6]. No cerebrovascular compression on the facial nerve was found during the operation. Pathological results showed the properties of lesion conforming to a cerebral cavernous angioma [Figure 7]. Therefore, the patient could be clearly diagnosed with multiple cerebral cavernous malformations. Postoperative examination demonstrated that hemifacial spasm had disappeared. At a 12-month follow-up period after surgery, his headache was alleviated and no recurrence of hemifacial spasm was detectable.
Figure 1: CT image showing hemorrhage in the right cerebellopontine angle

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Figure 2: CT image also showing multiple irregular high-density lesions in the cerebrum

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Figure 3: Preoperative susceptibility weighted imaging showing the cerebrum having several interspersed features of a low-signal hemosiderin ring around a high-signal popcorn ball-like appearance of a cavernous angioma

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Figure 4: Preoperative susceptibility weighted imaging showing the hemorrhagic lesion intimately compressing the facial nerve in the cerebellopontine angle

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Figure 5: Preoperative contrast enhanced magnetic resonance angiography showing two vascular, high-signal intensity lesions

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Figure 6: Postoperative CT image showing complete resection of the hemorrhagic lesion and removal of the intracranial hematoma

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Figure 7: The thin-walled and honeycomb-structured vascular lacunae characteristic of a cavernous angioma (Haematoxylin-eosin, 200×)

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While it is acknowledged that hemifacial spasm is usually caused by a vascular compression on the facial nerve, often at its point of origin from the brain stem,[1] a few studies have also shown that a cavernous angioma or a venous angioma may be responsible for hemifacial spasm as well[2],[3] [Table 1]. In fact, both a cavernous angioma or a venous angioma have been directly implicated in the compression on the facial nerve from its point of origin at the facial nucleus. This also implies that the treatment of hemifacial spasm in the presence of an intra-axial brainstem hemangiomatous lesion, merely by microvascular decompression surgery, may lead to a poor prognosis. The enlargement of the cavernous malformation may result in progressive compression of the facial nerve.[4]
Table 1: Literature review of hemifacial spasm associated with a cavernous angioma or a venous angioma treated by cerebellopontine angle surgery

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The natural history of cerebral cavernous malformations located in deep locations usually suggests a high risk for hemorrhage.[5] Our case illustrated the fact that compared with other sites, the cerebellopontine angle may also be a significant location for the development of hemorrhage in a cerebral cavernous malformation, which may often be overlooked. We report this case to recommend that an early magnetic resonance imaging may be helpful in establishing the etiological diagnosis in the presence of long-standing hemifacial spasm; a vigilant attention must be paid to the risk of hemorrhage in the presence of a cerebral cavernous malformation located in the cerebellopontine angle area; and, an early surgical procedure is mandated to prevent the occurrence of this complication.

Acknowledgment

The authors would like to thank Lixin Miu and Wei Su from the Imaging Center of Shengli Oilfield Central Hospital for helping with the images for this article.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK. Microvascular decompression of cranial nerves: Lessons learned after 4400 operations. J Neurosurg 1999;90:1-8.  Back to cited text no. 1
    
2.
Arita H, Kishima H, Hosomi K, Iwaisako K, Hashimoto N, Saitoh Y, et al. Hemifacial spasm caused by intra-axial brainstem cavernous angioma with venous angiomas. Br J Neurosurg 2012;26:281-3.  Back to cited text no. 2
    
3.
Chen HJ, Lee TC, Lui CC. Hemifacial spasm caused by a venous angioma. J Neurosurg 1996;85:716-7.  Back to cited text no. 3
    
4.
Kivelev J, Niemela M, Kivisaari R, Dashti R, Laakso A, Hernesniemi J. Long-term outcome of patients with multiple cerebral cavernous malformations. Neurosurgery 2009;65:450-5.  Back to cited text no. 4
    
5.
Washington CW, McCoy KE, Zipfel GJ. Update on the natural history of cavernous malformations and factors predicting aggressive clinical presentation. Neurosurg Focus 2010;29:E7.  Back to cited text no. 5
    


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