A case of hemifacial spasm caused by an artery passing through the facial nerve

Abstract

Hemifacial spasm (HFS) is a clinical syndrome characterized by unilateral facial nerve dysfunction. The usual cause involves vascular compression of the seventh cranial nerve, but compression by an artery passing through the facial nerve is very unusual. A 20-year-old man presented with left facial spasm that had persisted for 4 years. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery (AICA) was revealed on magnetic resonance angiography. During microvascular decompression surgery, penetration of the distal portion of the facial nerve root exit zone by the AICA was observed. At the penetrating site, the artery was found to have compressed the facial nerve and to be immobilized. The penetrated seventh cranial nerve was longitudinally split about 2 mm. The compressing artery was moved away from the penetrating site and the decompression was secured by inserting Teflon at the operative site. Although the facial spasm disappeared in the immediate postoperative period, the patient continued to show moderate facial weakness. At postoperative 12 months, the facial weakness had improved to a mild degree. Prior to performing microvascular decompression of HFS, surgeons should be aware of a possibility for rare complex anatomy, such as compression by an artery passing through the facial nerve, which cannot be observed by modern imaging techniques.

Keywords: Facial nerve; Facial weakness; Hemifacial spasm; Penetrating artery.

Fig. 1. Preoperative magnetic resonance angiography. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery is observed.

Fig. 2. Intraoperative findings. Penetration of the distal portion of the facial nerve root exit zone by the anterior inferior cerebellar artery is revealed (arrow). After longitudinally splitting the penetrated nerve, the compressing artery was moved away from the penetrating site and the decompression was secured by insertion of Teflon.

Fig. 3. Postoperative photographs. The patient showed moderate facial weakness although the facial spasm disappeared in the immediate postoperative period (A and B). After 4 months of follow-up (C and D), the facial weakness had improved to a mild degree, from House and Brackmann grade 4 to 2.