Endoscopic assisted microvascular decompression for vertebral artery - Associated hemifacial spasm – A case report

INTRODUCTION: and importance: Vertebral-artery associated hemifacial spasm is rare. Microvascular decompression (MVD) of hemifacial spasm (HFS) associated with the vertebral artery (VA) shows high rates of incomplete cure and complications compared to non-VA-related HFS. CASE PRESENTATION: A 39-year-old male who presented with a 2-year history of progressive left-sided typical HFS. Endoscopic assisted MVD for VA-associated HFS via a retro-sigmoid keyhole was performed. Neurovascular conflicts by both the VA and the AICA around the root exit zone of the facial nerve in sandwich type were successfully decompressed. CLINICAL DISCUSSION: Vertebral-artery associated hemifacial spasm is challenging. With the assistance of endoscopy, multiple neurovascular conflicts were clearly demonstrated without significant cerebellar retraction. The VA and AICA were safely interposed with preservation of perforators under excellent view. CONCLUSION: Endoscopic assisted MVD offers reliable decompression with minimum invasiveness in case of VA-associated HFS with multiple compressions.