J Korean Neurosurg Soc.  2012 Jan;51(1):59-61. 10.3340/jkns.2012.51.1.59.

Hemifacial Spasm Developed after Contralateral Vertebral Artery Ligation

• Choi HJ
• Lee SH
• Choi SK
• Rhee BA

• KMID: 2190476
• DOI: http://doi.org/10.3340/jkns.2012.51.1.59

Abstract

Although the mechanism of hemifacial spasm (HFS) is not yet well established, vascular compression of the facial nerve root exit zone and hyperexcitability of the facial nucleus have been suggested. We report a case of HFS in the setting of coinciding intracranial hemorrhage (ICH) of the pons and proximal ligation of the contralateral vertebral artery (VA) for the treatment of a fusiform aneurysm of the distal VA and discuss the possible etiologies of HFS in this patient. A 51-year-old male with an ICH of the pons was admitted to our hospital. Neuroimaging studies revealed an incidental fusiform aneurysm of the right VA distal to the origin of the posterior inferior cerebellar artery. Eight months after proximal ligation of the VA the patient presented with intermittent spasm of the left side of his face. Pre- and post-ligation magnetic resonance angiography revealed an enlarged diameter of the VA. The spasm completely disappeared after microvascular decompression.

Keyword

Hemifacial spasm; Vertebral artery; Ligation; Aneurysm; Decompression; Hemodynamics

MeSH Terms

Aneurysm
Arteries
Decompression
Facial Nerve
Hemifacial Spasm
Hemodynamics
Humans
Intracranial Hemorrhages
Ligation
Magnetic Resonance Angiography
Male
Microvascular Decompression Surgery
Middle Aged
Neuroimaging
Pons
Spasm
Vertebral Artery

Figure

• 

  Fig. 1 A : An axial computed tomography scan without contrast medium on admission, shows a hematoma in the lower pons. B : Right lateral view of vertebral angiogram, shows a fusiform aneurysm of the right vertebral artery, distal to the origin of the posterior inferior cerebellar artery.

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  Fig. 2 A : A short range 3D magnetic resonance angiography (MRA). 7th nerve root exit zone compressed by the VA (arrowhead). Pre- (B) and 20-month post-ligation MRAs (C). The fusiform aneurysm is not visible postoperatively with intact patency of right PICA (arrows). Note enlargement in diameter of left VA after treatment (double arrowheads). VA : vertebral artery, PICA : posterior inferior cerebellar artery.

• 

  Fig. 3 Intraoperative microscopic findings. A : The facial nerve REZ and proximal facial nerve are pressed by the VA (arrow). B : Vascular decompression by Teflon-felt insertion. REZ : root exit zone, VA : vertebral artery.

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