Hemifacial spasm caused by a tortuous recurrent perforating artery: A case report

Area of Science:

• Neurosurgery
• Vascular Neurology

Background:

• Hemifacial spasm (HFS) diagnosis can be challenging when the offending vessel is unclear.
• Microvascular decompression (MVD) is the primary surgical treatment for HFS, but a ~10% failure rate exists, often due to misidentification of the culprit vessel.

Observation:

• A case of HFS was treated where the typical anterior inferior cerebellar artery (AICA) was not the cause.
• Intraoperative findings revealed a tortuous recurrent perforating artery (RPA) forming a coil-shaped twist, compressing the facial nerve near the root detachment point.

Findings:

• The RPA, an aberrant branch of the AICA, was identified as the occult culprit responsible for focal neurovascular compression causing HFS.
• Surgical decompression of the RPA resulted in immediate and complete resolution of hemifacial spasm, with sustained relief at 1-year follow-up.

Implications:

• Intraoperative identification and decompression of atypical vascular compression, particularly involving RPAs, are critical for improving MVD surgical outcomes in HFS.
• Careful inspection of the RPA during MVD for HFS is recommended to prevent surgical failure and ensure patient recovery.