Abstract:

Objective To explore the strategy of microvascular decompression (MVD) on patients with hemifacial spasm complicated with trigeminal neuralgia. Methods Nine patients with hemifacial spasm complicated with trigeminal neuralgia treated with MVD were selected. The conditions of cerebrovascular diseases were examined by three dimensional time of flight (3D-TOF) nuclear magnetic resonance (MRI). The intraoperative findings as well as outcomes were analysed. Results Preoperative MRI revealed that the big twisted vertebral arteries (VA) deviated to the affected side, and even the contralateral VA moved to the affected side. It was observed during operation that VA directly compressed both facial and trigeminal nerves in 3 patients, VA lifted the posterior inferior cerebellar arteries (PICA) or the anterior inferior cerebellar arteries (AICA) in 5 patients which compressed both facial and trigeminal nerves, and PICA and superior cerebellar artery compressed facial and trigeminal nerves respectively in one patient. The symptoms of hemifacial spasm and trigeminal neuralgia disappeared immediately after operation in 8 patients. For the other patient, the pain relieved one week after operation, and the symptoms completely disappeared 3 months after operation. There was no reoccurrence during the follow-up. Conclusion Large and dislocated VA may often be the direct and indirect responsible vessels for hemifacial spasm complicated with trigeminal neuralgia. The key to the operation is to move the VA proximally instead of stucking barely the pad between the nerve and vessel.

Key words: hemifacial spasm, trigeminal neuralgia, microvascular decompression, vertebral artery