Hemifacial spasm and neurovascular compression syndrome

Description

A 49-year-old woman experienced left orbicularis oculi muscle spasms for 16 months. The first 5 months were characterised by rare involuntary spasms, became stronger at any physical or mental activity and later they even occurred while the patient was resting, causing contraction of all the muscles innervated by the left seventh cranial nerve. MR angiography revealed a neurovascular compression of the left facial nerve by the anterior inferior cerebellar artery (AICA) (figures 1 and 2). The patient was taken to surgery and a microvascular decompression through a retrosigmoid approach was performed. Facial nerve function monitoring was conducted intraoperatively.

Figure 1

Preoperative 3T MRI: highly T2-weighted sequences for cisternography. Red arrow: anterior inferior cerebellar artery loop. White arrow: facial nerve at root exit zone.

Figure 2

Preoperative 3T time-of-flight MRI angiography sequence. Red arrow: anterior inferior cerebellar artery  loop site...

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