First description of neurogenic sinus bradycardia in idiopathic hemifacial spasm

BackgroundIdiopathic HFS accompanied by NSB is a rare clinical phenomenon and has not been reported before. Here we describe this phenomenon and discuss its mechanism and treatment.MethodsEighteen patients with idiopathic HFS with NSB (HR ≤55 BPM) received MVD operations. Their sinus bradycardia was proved to be neurogenic by a series of examinations. During MVD, all 18 patients were found to have their REZ of facial and vagus nerves or VMO compressed by intracranial arteries. Decompression at REZ of facial and vagus nerves and/or VMO was enforced in MVD operations. Preoperative and postoperative HR and the therapeutic efficacy of MVD for HFS with NSB were recorded.ResultsFourteen cases (77.78%) were right-sided HFS. The symptom of facial spasm disappeared in 16 cases and was relieved in 1 case a year after MVD. The mean HR before MVD was 52 ± 2.81 BPM. The mean HRs 1 week and 1 year after MVD were 63.39 ± 5.26 and 63.17 ± 6.46 BPM, respectively, both of which were significantly higher (P < .01) than the preoperative HR.ConclusionsMost NSBs occurred in right-sided HFS. Decompression at REZ of facial and vagus nerves and/or VMO simultaneously was an effective treatment of HFS and NSB in HFS accompanied by NSB. Severe artery compression at vagus or VMO might be the cause of NSB in HFS.