Double Crush Syndrome as a Cause of Hemifacial Spasm

Hemifacial spasm is a rare but debilitating disorder of vascular compression of the facial nerve at the root exit zone causing repetitive, uncontrolled spasm of one half of the face. Usually, compression is caused by a pulsatile artery and less often by venous. Rarely, however, is hemifacial spasm caused by simultaneous compression by two formally named blood vessels. Here, we report a case of hemifacial spasm caused by simultaneous compression of the facial nerve root exit zone by the anterior inferior cerebellar artery and the superior petrosal vein. We describe the operative technique utilized to decompress the facial nerve and discuss the consequences of venous sacrifice in this scenario.