Treatment of Hemifacial Spasm With Endovascular Stenting of the Vertebral Artery

Hemifacial spasm (HFS) is a movement disorder characterized by involuntary spasms of the facial muscles that can lead to debilitating symptoms and is typically caused by vascular compression. Classically, microvascular decompression of the offending vessel is the gold standard; however, in certain cases, microvascular decompression may have increased risk because of patient comorbidities and underlying anatomy. In this report, we describe a unique endovascular approach with flow diversion for the treatment of HFS.

A 70-year-old woman presented to the clinic with a 5-year history of HFS on the right side progressing from the eye to the entire face. Surgical and endovascular treatment options were discussed, and the patient was ultimately treated with an endovascular stenting with flow diversion of the vertebral artery (VA). Immediately after the procedure, the patient's spasms did not resolve; however, at the 3-month and 6-month follow-ups, her spasms had significantly reduced and progressively improved the patient's quality of life.

The significant decrease in the frequency of spasms illustrates that by stenting the parent vessel of the offending artery, the VA in this case, the compression at the facial nerve root exit zone was relieved. This suggests that stenting can change the geometry of the VA and decrease the pressure exerted on the root exit zone, resolving the spasm and providing an alternative approach for the treatment of HFS.