Microvascular decompression for developmental venous anomaly causing hemifacial spasm: illustrative case

Abstract

Background: Developmental venous anomaly (DVA) is a rare cause of hemifacial spasm (HFS). The treatment of HFS caused by a DVA varies in the literature and includes medication management, botulinum toxin injections, and microvascular decompression (MVD).

Observations: A 64-year-old woman presented with right-sided HFS. Preoperative magnetic resonance imaging showed a DVA in the right inferior pons, with an enlarged segment compressing the facial nerve at its root detachment point prior to drainage into the superior petrosal sinus. MVD was performed, and the facial nerve was decompressed without sacrifice of the vein. Immediately following the procedure, the patient had significantly reduced spasms. The patient became spasm-free 3 months after MVD and maintained spasm freedom for 3 months. Six months after MVD, the patient had a partial return of spasms. At 8 months, the patient continued to have reduced and intermittent spasms in the right orbicularis oculi muscle.

Lessons: MVD for HFS caused by a DVA is a safe procedure and can be effective at reducing spasm frequency and severity.

Keywords: case report; developmental venous anomaly; hemifacial spasm; microvascular decompression; pontine.

FIG. 1

Preoperative axial (A–C) and sagittal (D–F) magnetic resonance imaging (MRI) sequences with contrast illustrating a developmental venous anomaly (DVA) (green arrow), the DVA (green circle, A) compressing the facial nerve (blue arrow), and the DVA (green circle, B and C) draining into the superior petrosal sinus.