Surgical management of coexisting trigeminal neuralgia and hemifacial spasm

Abstract

Background: Coexisting hemifacial spasm (HFS) and trigeminal neuralgia (TN) without any mass lesion in the posterior fossa is a rare condition. Hence, the surgical strategy of coexisting HFS and TN has rarely been discussed.

Case description: We present a rare case of coexisting HFS and TN without any mass lesion in posterior fossa having microvascular confliction of trigeminal nerve with superior cerebellar artery (SCA) and facial nerve with anterior inferior cerebellar artery (AICA). Single surgery was performed for both trigeminal nerve and facial nerve. Mobilization of vessels and placement of Teflon between the nerve and vessel relieved the symptoms immediately after the operation. We have reviewed the literature for cases with coexistent HFS and TN. The treatment strategy for such cases has been discussed. The surgical treatment has been demonstrated with a video.

Conclusion: A single surgery is a safe and effective option to treat coexistent HFS and TN due to microvascular confliction.

Keywords: Combined hyperactive syndrome of cranial nerves; decompression surgery; hemifacial spasm; trigeminus neuralgia.

Figure 1

MRI images (a-c) showing microvascular confliction of SCA with trigeminal nerve (a) and AICA with facial nerve (b and c). Postoperative cranial CT scan is showing no complications (d-f)

Figure 2

Intraoperative images are showing avascular conflict of SCA with trigeminal nerve (left) and AICA with facial (right) nerve (a), reposition of AICA (a and b), and placement of Teflon between SCA and trigeminal nerve (c and d)