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array:22 [ "pii" => "S252984962400039X" "issn" => "25298496" "doi" => "10.1016/j.neucie.2024.07.004" "estado" => "S200" "fechaPublicacion" => "2024-08-05" "aid" => "620" "copyrightAnyo" => "2024" "documento" => "article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S1130147324000794" "issn" => "11301473" "doi" => "10.1016/j.neucir.2024.07.004" "estado" => "S200" "fechaPublicacion" => "2024-08-14" "aid" => "620" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Espasmo hemifacial asociado a neuralgia trigeminal secundario a compresión vascular trigeminal" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Hemifacial spasm associated with trigeminal neuralgia secondary to trigeminal vascular compression" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2546 "Ancho" => 1583 "Tamanyo" => 617718 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">A y B) Imágenes preoperatorias de la paciente en el momento que se está produciendo el EHF del lado izquierdo. C y D) Imágenes posoperatorias de la paciente, con resolución completa del EHF.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ernesto F. Ardisana Santana, Juan F. Villalonga-Penna, Mauro M. Suárez Marin, Alvaro Campero" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ernesto F." "apellidos" => "Ardisana Santana" ] 1 => array:2 [ "nombre" => "Juan F." "apellidos" => "Villalonga-Penna" ] 2 => array:2 [ "nombre" => "Mauro M." "apellidos" => "Suárez Marin" ] 3 => array:2 [ "nombre" => "Alvaro" "apellidos" => "Campero" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S252984962400039X" "doi" => "10.1016/j.neucie.2024.07.004" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S252984962400039X?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147324000794?idApp=UINPBA00004B" "url" => "/11301473/unassign/S1130147324000794/v1_202408141007/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2529849624000479" "issn" => "25298496" "doi" => "10.1016/j.neucie.2024.07.008" "estado" => "S200" "fechaPublicacion" => "2024-08-05" "aid" => "619" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 0 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Decompressive craniectomy in the acute fulminant cerebral edema" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel de la craniectomía descompresiva en el edema cerebral fulminante agudo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 505 "Ancho" => 1347 "Tamanyo" => 93972 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Brain computed tomography (CT) images (A) CT scan prior to surgical indication: loss of cortico-subcortical differentiation symmetrically and bilaterally in both frontal lobes and anterior portion of parietal and temporal lobes. Also visible are complete collapse of the sulci of both convexities and a decrease in the subarachnoid cisterns and almost complete collapse of the 4th ventricle. These findings are consistent with diffuse cerebral oedema. (B) CT scan 24 h after surgery: postoperative changes secondary to bilateral frontal craniectomy. Significant loss of cortico-subcortical differentiation suggestive of diffuse cerebral oedema still identifiable. Slight improvement in bilateral frontal basal parenchymal density and slight re-expansion of the 4th ventricle. (C) CT scan prior to bone replacement: 21 days after surgery. Postoperative changes showing an extra-axial frontal hypodense collection. The lesions are more sharply defined and hypodense than in the previous study.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Aida Antuña Ramos, Juan Mayordomo-Colunga, Raquel Blanco Lago, Marco Antonio Álvarez Vega" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Aida" "apellidos" => "Antuña Ramos" ] 1 => array:2 [ "nombre" => "Juan" "apellidos" => "Mayordomo-Colunga" ] 2 => array:2 [ "nombre" => "Raquel" "apellidos" => "Blanco Lago" ] 3 => array:2 [ "nombre" => "Marco Antonio" "apellidos" => "Álvarez Vega" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1130147324000769" "doi" => "10.1016/j.neucir.2024.07.003" "estado" => "S200" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147324000769?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849624000479?idApp=UINPBA00004B" "url" => "/25298496/unassign/S2529849624000479/v1_202408050416/en/main.assets" ] "itemAnterior" => array:16 [ "pii" => "S2529849624000352" "issn" => "25298496" "doi" => "10.1016/j.neucie.2024.06.003" "estado" => "S200" "fechaPublicacion" => "2024-07-11" "aid" => "615" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>" "titulo" => "Integrating endovascular techniques into established open neurosurgery practice: a temporal analysis of treatment evolution in a dual-trained neurosurgical unit" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Integración de técnicas endovasculares en la práctica de la neurocirugía abierta: análisis temporal de la evolución del tratamiento en una unidad de neurocirugía vascular dual" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1526 "Ancho" => 2508 "Tamanyo" => 226263 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The graph illustrates the evolution of treatment modality preferences over time, as represented by the rolling average proportion of EN (ENDO) and ON (OPEN) neurosurgical procedures. The navy blue line indicates the proportion of OPEN procedures, while the crimson line represents the ENDO procedures.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ignacio Arrese, Sergio García-García, Santiago Cepeda, Rosario Sarabia" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Arrese" ] 1 => array:2 [ "nombre" => "Sergio" "apellidos" => "García-García" ] 2 => array:2 [ "nombre" => "Santiago" "apellidos" => "Cepeda" ] 3 => array:2 [ "nombre" => "Rosario" "apellidos" => "Sarabia" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849624000352?idApp=UINPBA00004B" "url" => "/25298496/unassign/S2529849624000352/v1_202407110420/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Hemifacial spasm associated with trigeminal neuralgia secondary to trigeminal vascular compression" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ernesto F. Ardisana, Juan F. Villalonga, Mauro M. Suárez, Alvaro Campero" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ernesto F." "apellidos" => "Ardisana" "email" => array:1 [ 0 => "ernestofas2018@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan F." "apellidos" => "Villalonga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Mauro M." "apellidos" => "Suárez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Alvaro" "apellidos" => "Campero" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Laboratorio de Innovaciones Neuroquirúrgicas de Tucumán (LINT), Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital General Angel C. Padilla, Tucumán, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Espasmo hemifacial asociado a neuralgia trigeminal secundario a compresión vascular trigeminal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2546 "Ancho" => 1583 "Tamanyo" => 596089 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A and B) preoperative images of the patient at the time the left-sided hemifacial spasm is occurring. (C and D) postoperative images of the patient, with complete resolution of the hemifacial spasm.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In 1977, Dr Peter J. Jannetta, wrote the first article where he reported as the cause of trigeminal neuralgia (TN) and hemifacial spasm (HFS) a possible vascular compression in the area of entry/exit to the brain stem of the trigeminal nerve (TgN) and facial nerve (FN).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Subsequent research confirmed this important contribution. The association of trigeminal neuralgia (TN) with ipsilateral HFS can be estimated at 1%, ranging between 0.5 and 3% of patients affected with HFS according to the literature.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">HFS is characterized by intermittent involuntary contractions of the muscles innervated by the FN with an incidence of 1/100,000 population. Typical symptoms of HFS begin with an involuntary movement of the eyelid that gradually progresses to involve the oral muscles.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> TN manifests as neuropathic facial pain, defined by the International Pain Society as “periodic, sudden, intense and transient tingling of the skin in the area innervated by one or more branches of the TgN.” Typical clinical features of TN include paroxysmal pain, remission, precipitating factors, and trigger points. The annual incidence of TN is 4.5–28.9/100,000. It is more common in middle-aged women, with the right side being more common than the left.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the case of overactive cranial nerve syndrome, the possibility of dolichoectasia of the vertebrobasilar artery is generally considered, which is common in women and also involves the glossopharyngeal nerve (GPN),<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> but there is the possibility, not common, of a mononeural compression and that due to the neurophysiological relationships, for example between the V and VII pair, stimuli capable of generating hyperactivity and the patient's symptoms are established, the objective of this study being to present a case where this latter situation is evident, through the abnormal activation of the trigemino-facial reflex.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 55-year-old white, right-handed woman, with no history of personal chronic diseases, unremarkable family history, reported left-sided HFS for 8 years, for which she was followed up by Neurology and periodically received 21 infiltrations with botulinum toxin.</p><p id="par0025" class="elsevierStylePara elsevierViewall">2 years ago, episodic pain of maximum severity was added to the clinical picture (VAS-10/10) in the region corresponding to the territory of V1 and V2 on the left side, which originated from stimulating trigger points, with characteristics of typical TN. The patient underwent several medical treatment regimens, the pain being refractory to them. The HFS remained between the pain crises, not being related to them.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The physical examination shows the patient conscious, oriented, without meningeal signs, with pupils isochoric and reactive to light, without ophthalmoparesis, with sustained, painless spasms, which begins in the orbicularis oculi of the affected side with subsequent irradiation to the face and mouth, including the forehead and platysma on the left side of the face and with reproduction of pain to sensory stimulation of the skin of the forehead and upper dental arch.</p><p id="par0035" class="elsevierStylePara elsevierViewall">MRI with protocol for neurovascular conflict showed a vessel in intimate contact with the entry zone of the left trigeminal nerve. At the level of the exit zone of the left facial nerve, the finding of a vessel in contact with the nerve was not clear (See <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and E).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The case is discussed in our group and with informed consent from the patient it is decided to perform surgery for microvascular decompression.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A left retrosigmoid approach was performed, in a semi-sitting position. First, the entry zone of the TgN was accessed through a lateral supracerebellar pathway, finding a clear conflict between the anterior inferior cerebellar artery and the lower sector of the sensory root of the TgN, with even a notch and change in colour at that level. Using a microsurgical technique, a fragment of Teflon was placed between the artery and the nerve, achieving adequate separation (See <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B–D).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Then, the trajectory was changed, and through a lateral infracerebellar route the exit zone of the FN was accessed, without identifying any type of vascular conflict. For greater safety, a 30-degree endoscope was used, and no vascular conflict was identified with the endoscopic view (See <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>F–H).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The patient's initial symptoms (See <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B), after surgery, presented complete resolution, both the HFS and the associated trigeminal pain. Medical follow-up at one year has shown no recurrence of the initial symptoms (See <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C and D).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">The pathophysiology of HFS and TN evidences an injury in the transition between the central myelin (originated by oligodendrocytes) and the peripheral myelin (originated by Schwann cells), creating patches of demyelination<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and anomalous activation of transmembrane sodium channels in the axons. This, combined with triggering factors such as transient fluctuations in blood pressure or pulse, causes these voltage-dependent channels to reach the threshold and generate action potentials that can be conducted by the damaged nerve.</p><p id="par0065" class="elsevierStylePara elsevierViewall">When the nerve is injured, Schwann cells and macrophages phagocytose the degenerated myelin, producing cytokines that further aggravate the demyelination.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The only radical solution for this cyclical destructive process is microvascular decompression.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In TN, the vessel responsible is usually the superior cerebellar artery, while in HFS it is usually the anterior inferior cerebellar artery. However, there are cases in which an enlarged or dolichoectatic vertebral artery can be the causative vessel of both TN and HFS, as well as NGF.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the case we present, this pathophysiological mechanism, which is the most common, partially explains the symptoms, since clear vascular compression was evident at the level of the TN, but not at the level of the FN. One hypothesis is that hyperactivation of the facial nerve is produced by a sustained and abnormal stimulation of the trigemino-facial reflex.</p><p id="par0075" class="elsevierStylePara elsevierViewall">At the end of the 1910s, the presence of HFS coexisting with facial pain due to compression of the TgN was described.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In the last 30 years, several series have been published describing the presence of HFS, with or without facial pain, in the context of trigeminal injury or compression.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> In the last decade, during skull base surgeries with intraoperative neurophysiological monitoring, the presence of robust electromyographic responses of muscles innervated by the facial nerve, evoked with stimulation of the TgN,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> which as a whole has been called the trigemino-facial reflex.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The structures involved in this response constitute an oligosynaptic reflex arc, formed by an afferent portion through the sensory branches of the TgN, which synapses in two structures: first, with the main sensory nucleus of the trigeminal located in the middle portion of the pons, which in turn synapses with the motor nucleus of the ipsilateral facial nerve. The second synapse of this afferent portion is with the nucleus of the trigeminal spinal tract in the rostral portion of the medulla oblongata, which in turn activates the nucleus of the facial nerve, both ipsilateral and contralateral.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">That is why today, in addition to these responses being able to be evoked and evaluated during physical examination (corneal reflex, corneomandibular reflex, etc.), the evocation of multiple trigeminal reflexes has also been widely implemented during intraoperative monitoring to promote the functional preservation of these structures, such as the blink reflex (trigeminal afferent branch and facial efferent branch<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and the hypoglossal trigeminal reflex.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0090" class="elsevierStylePara elsevierViewall">In a patient with HFS with or without pain (our patient spent 6 years without pain), during microvascular decompression of the FN, if frank proximal compression is not evident, the trigeminofacial structural relationship must be taken into account, making it necessary to explore the TN.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding for this publication</span><p id="par0095" class="elsevierStylePara elsevierViewall">No.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2215407" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1857266" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2215408" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1857267" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding for this publication" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "xack763603" "titulo" => "Acknowledgement" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-04-06" "fechaAceptado" => "2024-07-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1857266" "palabras" => array:5 [ 0 => "Hemifacial spasm" 1 => "Trigeminal neuralgia" 2 => "Microvascular decompression" 3 => "Teflon sheet" 4 => "Trigemino-Facial reflex" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1857267" "palabras" => array:5 [ 0 => "Espasmo hemifacial" 1 => "Neuralgia trigeminal" 2 => "Descompresión microvascular" 3 => "Lámina de teflón" 4 => "Reflejo trigémino-facial" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The coincidence in a patient of Hemifacial Spasm and Trigeminal Neuralgia is not frequent. A case is presented with the objective of showing this association due to the abnormal activation of the Trigemino-Facial Reflex.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A 55-year-old woman with an 8-year history of left-sided hemifacial spasm and typical trigeminal pain in the ipsilateral V1 and V2 territory.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The physical examination shows spasms in the left hemiface, with reproduction of intense pain upon sensory stimulation of the skin on the forehead and upper dental arch.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The MRI showed a vessel in intimate contact with the entrance area of ​​the left trigeminal nerve.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A left retrosigmoid approach was performed. First, the entrance area of ​​the trigeminal nerve was accessed, finding a clear vascular conflict, which was isolated with Teflon. Then, the trajectory was changed and the exit zone of the facial nerve was accessed, and no type of vascular conflict was identified.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The patient presented complete resolution of the Hemifacial Spasm and the associated trigeminal pain.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The analysis of this case allows us to conclude that during microvascular decompression of the Facial Nerve, if frank proximal compression is not evident, the Trigeminofacial structural relationship must be taken into account, making it necessary to explore the Trigeminal Nerve.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La coincidencia en un paciente de espasmo hemifacial y de neuralgia trigeminal no es frecuente. Se presenta un caso con el objetivo de mostar esta asociación por la activación anormal del reflejo trigémino-facial.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Mujer de 55 años, con antecedentes de 8 años de espasmo hemifacial de lado izquierdo y dolor trigeminal típico en el territorio de V1 y V2 ipsilateral.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El examen físico muestra espasmos en hemicara izquierda, con reproducción de dolor intenso al estímulo sensitivo de la piel en la frente y arcada dentaria superior.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La RM mostró un vaso en íntimo contacto con la zona de entrada del nervio trigémino izquierdo.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se realizó un abordaje retrosigmoideo izquierdo. Primero se accedió a la zona de entrada del nervio trigémino encontrándose un claro conflicto vascular, el cual se aisla con teflón. Luego, se cambió de trayectoria y se accedió a la zona de salida del nervio facial, no identificandose ningun tipo de conflicto vascular.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La paciente presentó resolución total del espasmo hemifacial y del dolor trigeminal asociado.</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">El análisis de este caso nos permite concluir que durante la descompresion microvascular del nervio facial si no se evidencia una franca compresión proximal, se debe tener en cuenta la relación estructural trigeminofacial, siendo necesario la exploración del nervio trigeminal.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2748 "Ancho" => 2425 "Tamanyo" => 695243 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) MRI at the level of the trigeminal nerve (T2 heavy and T1 sequences with gadolinium). A vascular conflict is observed in the lower part of the nerve. (B–D) microsurgical images. (B and C) The vascular conflict can be seen with the generation of a deformation of the trigeminal nerve caused by the cerebellar artery. (D) Teflon placed between the artery and the nerve. (E) MRI at the level of the facial nerve (T2 heavy and T1 sequences with gadolinium). No clear vascular conflict is observed. (F) Microsurgical image. No vascular conflict is seen in the exit zone of the facial nerve. (G and H) Endoscope images. No vascular conflict is seen in the exit zone of the facial nerve.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2546 "Ancho" => 1583 "Tamanyo" => 596089 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A and B) preoperative images of the patient at the time the left-sided hemifacial spasm is occurring. (C and D) postoperative images of the patient, with complete resolution of the hemifacial spasm.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Observations on the etiology of trigeminal neuralgia, hemifacial spasm, acoustic nerve dysfunction and glossopharyngeal neuralgia. Definitive microsurgical treatment and results in 117 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.J. 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