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212 www.apjo.org Asia-Pacic Journal of Ophthalmology & Volume 4, Number 4, July/August 2015
Copyright 2015 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited.
Asia-Pacic Journal of Ophthalmology & Volume 4, Number 4, July/August 2015 Neurovascular Contact in Patients With HFS
Copyright 2015 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited.
Jariyakosol et al Asia-Pacic Journal of Ophthalmology & Volume 4, Number 4, July/August 2015
as microvascular decompression is necessary, an MRA may be The vertebrobasilar artery was the most common area of
considered for further investigation. vascular compression in our study. Frazier et al12 explained
This study found a relationship between right-sided symp- that arteriosclerotic changes were prone to develop in the verte-
toms and neurovascular contact in HFS. To our knowledge, no brobasilar artery in patients with accompanied hypertension, di-
anatomical relationship was explainable. Further study is neces- abetes mellitus, hyperlipidemia, and obesity.
sary to explore this relationship. The limitations of this study were the small sample size
In reviewing previous studies, diabetes mellitus was and the fact that the MRI strength was not dened because of
not found to be a strongly associated factor. Diabetes mellitus the retrospective review of data. However, most MRI tech-
was detected as a non-statistically signicant associated factor niques used were advanced and ensured highly sensitive de-
in this study (P = 0.051), but the result showed a high OR (OR, tection of neurovascular compression. Leal et al13 found that
9.99; 95% CI, 0.99Y96.34). A limitation of this study was the 3 T MRI demonstrated a statistically signicant improvement
relatively small sample size, which may not have sufcient compared with the same protocol using 1.5 T in visualization of
power to detect signicant association, and this was reected in veins in neurovascular compression of the trigeminal nerve and
the very wide CI. The pathophysiology of vascular disease in determination of the exact compression site. However, there
common in diabetes involves abnormalities in endothelial cells, was no statistically signicant improvement in detecting arterial
vascular smooth muscle cells, and platelet function. These ab- neurovascular compression and determining the severity of com-
normalities contribute to the cellular events that cause athero- pression. Further studies are warranted to compare the diagnostic
sclerosis.11 We hypothesized that atherosclerotic change may accuracy between 3 and 1.5 T in detecting neurovascular contact
lead to tortuosity of vessels and cause the pulsatile compression in patients with HFS.
of the facial nerve at the REZ. Further studies with a larger In conclusion, the prevalence of neurovascular contact at
patient sample are required to determine the association be- the REZ in patients with HFS was 41.7%. The prevalence was
tween diabetes mellitus and neurovascular contact in patients higher in the older age group. Right-sided symptoms were sig-
with HFS. nicantly associated with this condition. This knowledge may
Defazio et al9 found that hypertension was signicantly aid in the decision-making process for imaging investigation of
associated with the outcome in the left-sided group (P = 0.008; patients with HFS.
OR, 4.0; 95% CI, 1.4Y11.5). In our study, hypertension was
not a statistically signicant associated factor (P = 0.445; OR,
1.51), but we found that this condition was the most common REFERENCES
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Copyright 2015 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited.
Asia-Pacic Journal of Ophthalmology & Volume 4, Number 4, July/August 2015 Neurovascular Contact in Patients With HFS
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It does not matter how slowly you go as long as you do not stop.
V Confucius
Copyright 2015 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited.