Facial nerve decompression of a PICA vessel loop: A case report

Facial nerve palsy is a common condition with various etiologies. However, compression due to a vessel loop is an exceptionally rare cause. This case report highlights the unusual presentation and management of facial nerve palsy caused by vascular compression, emphasizing the importance of considering rare etiologies in persistent cases.

We describe the case of a young female patient who presented with a history of right blepharospasm and facial muscle twitching for several years. Cranial magnetic resonance imaging (MRI) revealed a posterior inferior cerebellar artery (PICA) vessel loop compressing the exit of the acoustofacial bundle at the level of the brainstem.

The patient's condition necessitated a microscopic surgical decompression to relieve the compression on the facial nerve. During the procedure, the facial nerve was freed and cushioned using Teflon. This intervention highlights the potential for surgical resolution in cases of facial nerve palsy caused by vascular compression, despite its rarity.

Postoperatively, the patient was free from blepharospasm and showed significant clinical improvement in facial muscle control. This case underscores the importance of considering vascular compression in the differential diagnosis of persistent facial nerve palsy and demonstrates the efficacy of surgical decompression in such cases.