Microvascular decompression in patient with atypical features of hemifacial spasm secondary to compression by a tortuous vertebrobasilar system: case report.
OBJECTIVE
We report a case of hemifacial spasm in a patient who had associated hearing loss, numbness throughout the face, tinnitus, and vertigo, all of which occurred when turning his head to the left. To our knowledge, these symptoms have not occurred in this pattern and with a single trigger.


METHODS
A 45-year-old man presented with a 3-year history of right-sided hemifacial spasm initially treated with botulinum toxin. One month before presentation, he had an episode of acute hearing loss in the right ear when turning his head to the left, followed by multiple episodes of transient hearing loss in his right ear, numbness in his right face in all distributions of the trigeminal nerve, tinnitus, and vertigo. He was found to have decreased sensation in nerves V1 to V3 and House-Brackmann grade 3/6 weakness in his right face, despite not having botulinum toxin injections in more than a year. Magnetic resonance imaging/angiography showed an ectatic vertebrobasilar system causing compression of the fifth, seventh, and eighth cranial nerves.


METHODS
The patient underwent a retromastoid craniotomy and microvascular decompression. Postoperatively, he had complete resolution of his symptoms except for his facial weakness. The benefit has been long-lasting.


CONCLUSIONS
Multiple, simultaneous cranial neuropathies from vascular compression are rare, but this case is an example of safe and effective treatment with microvascular decompression with durable results.
Perlmutter
David H
DH
Department of Neurological Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Petraglia
Anthony L
AL
Barbano
Richard
R
Schwalb
Jason M
JM
D001488:Basilar Artery / Q000002:abnormalities* / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical; D005155:Facial Nerve Diseases / Q000209:etiology* / Q000601:surgery; D019569:Hemifacial Spasm / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008833:Microcirculation; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D014711:Vertebral Artery / Q000002:abnormalities* / Q000601:surgery; D014715:Vertebrobasilar Insufficiency / Q000209:etiology* / Q000601:surgery