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Published on: July 21, 2013
Hemifacial spasm developed after contralateral vertebral artery ligation
Hyuk Jai Choi1, Sung Ho Lee, Seok Keun Choi
1Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Korea.
Journal of Korean Neurosurgical Society
|March 8, 2012
Summary
Vascular compression of the facial nerve may cause hemifacial spasm (HFS). A patient with pontine hemorrhage and vertebral artery ligation developed HFS, which resolved after microvascular decompression, suggesting vascular compression as a cause.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Surgery
Background:
- The exact mechanism of hemifacial spasm (HFS) remains unclear, with theories including vascular compression of the facial nerve root exit zone and facial nucleus hyperexcitability.
- Intracranial hemorrhage (ICH) and vertebral artery (VA) abnormalities are potential contributing factors.
Observation:
- A 51-year-old male with pontine ICH and a distal VA fusiform aneurysm underwent proximal VA ligation.
- Eight months post-ligation, he developed left-sided facial spasms (HFS).
- Neuroimaging revealed an enlarged VA diameter after ligation.
Findings:
- The patient's HFS completely resolved following microvascular decompression surgery.
- This suggests that the altered hemodynamics or compression related to the VA ligation and aneurysm contributed to the HFS.
Implications:
- This case highlights a potential, albeit uncommon, link between vertebral artery interventions, vascular changes, and the development of hemifacial spasm.
- Microvascular decompression remains an effective treatment for HFS, even in complex cases involving vascular anomalies.
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