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Simultaneous microvascular decompression for trigeminal neuralgia and hemifacial spasm involving a dolichoectatic vertebral artery in an elderly patient: illustrative case

Neelan J. Marianayagam, Hanya M. Qureshi, Sagar Vasandani, Shaurey Vetsa, Muhammad Jalal, Kun Wu, and Jennifer Moliterno

Trigeminal neuralgia (TN) and hemifacial spasm (HFS) refractory to medical management can commonly be the result of direct contact by an aberrant vessel compressing the root entry zone (REZ) of the trigeminal and facial nerves, respectively. Microvascular decompression (MVD) has been shown to provide lasting relief. 1 In TN, the offending vessel is usually the superior cerebellar artery, whereas in HFS, it is usually the anterior inferior cerebellar artery. There are instances, however, in which an enlarged or dolichoectatic vertebral artery (DVA) can be the

Open access

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

Margaret Tugend and Raymond F Sekula Jr.

DVA or a decrease in outflow from the DVA. Symptoms from flow-related causes include headache, neurological deficit, seizures, and coma secondary to hemorrhage or infarction. Mechanical causes include obstructive hydrocephalus and nerve compression, causing trigeminal neuralgia and HFS. Cases with symptoms attributed to DVA, such as headache, but with no identifiable patho-mechanism, are classified as idiopathic. 5 Here, we present an example of mechanical compression of the facial nerve by a pontine DVA ostensibly causing HFS. Although the patient ultimately had a