Microvascular Decompressions in Patients With Coexistent Hemifacial Spasm and Trigeminal Neuralgia

BACKGROUND: Although microvascular decompression (MVD) is widely accepted as the effective therapy for hemifacial spasm (HFS) or trigeminal neuralgia (TN), the surgical treatment of coexistent HFS and TN in an individual is seldom addressed. OBJECTIVE: To discuss the operative strategy of MVD for both the hemifacial and trigeminal nerves. METHODS: Nine consecutive cases of coexistent HFS and TN caused by neurovascular confliction in the same side were studied. Except for one, the patients suffered from HFS followed by ipsilateral TN. All patients underwent MVD and were followed up for 3 to 30 months. Each surgery was analyzed retrospectively. RESULTS: Intraoperatively, a looped vertebral artery (VA) shifted to the suffered side was found in 8 patients. The VA was regarded as the direct or indirect offending artery. After MVDs, the spasm ceased immediately in 6 patients; the other 3 patients had delayed relief within 3 months. The pain disappeared immediately in 7 of 9 patients. One patient felt relief after a week, and 1 had pain but improved slightly. No recurrence or complication was found. CONCLUSION: A shifted VA loop may account for this tic convulsif syndrome. MVD is a reasonable and effective therapy with a high cure rate for the disease. The key to the surgery is to move the VA proximally. The dissection should be performed rostrally starting from the caudal cranial nerves.