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Updated: Oct 15, 2026

Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Flow diversion for vertebral artery fusiform/dissecting aneurysm-related hemifacial spasm: illustrative cases
Jun Hashimoto1, Takeshi Miyata1, Yoshitaka Tsujimoto1
1Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan.
Background:
Hemifacial spasm (HFS) results from pulsatile neurovascular conflict at the facial nerve root exit zone (REZ) and is treated with microvascular decompression (MVD). Aneurysm-related HFS is rare, and evidence for flow diversion (FD) is limited.
Observations:
Two women with vertebral artery (VA) fusiform/dissecting aneurysms presented with ipsilateral HFS and underwent flow diverter treatment. Case 1 had bilateral fusiform VA aneurysms; the symptomatic left V4 lesion compressed the REZ without branch incorporation. Overlapping Pipeline Shield devices achieved complete occlusion and durable HFS resolution. Case 2 had a left V4 dissecting aneurysm incorporating the posterior inferior cerebellar artery (PICA). A FRED flow diverter reduced aneurysmal filling and transiently improved HFS, but residual filling persisted mainly around the PICA origin and symptoms recurred. Nineteen months later, lateral suboccipital MVD transposed the VA-PICA complex away from the REZ with sustained control.
Lessons:
FD can cure aneurysm-related HFS without craniotomy when complete exclusion is feasible and no critical branch is incorporated. In branch-bearing lesions, incomplete occlusion and persistent contact may cause recurrence; structured follow-up and readiness for staged MVD are essential. Given rupture risk, staged MVD after aneurysm stabilization may be considered in selected cases when symptoms persist or recur. https://thejns.org/doi/10.3171/CASE26430.
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