Hemifacial Spasm Caused by Compression of a Vertebral Artery Aneurysm Consequently Improved by Stent-assisted Coil Embolization

Objective: We described a rare hemifacial spasm (HFS) caused by compression of a vertebral artery (VA) aneurysm that was consequently improved by stent-assisted coil embolization.

Case presentation: A 60-year-old man presented with a chief complaint of left HFS that had persisted for 1 month. It had initially appeared in the orbicularis oculi, spread to the orbicularis oris, and severely disrupted his quality of life. Both MRI and MRA revealed a wide-necked aneurysm of the left VA (neck 8.5 mm, dome 6.0 mm) compressing the left facial nerve root exit zone (REZ). We performed stent-assisted coil embolization because the VA was dominant at this side of the aneurysm and we tried to preserve normal antegrade flow. The HFS disappeared immediately after embolization without complications. After 6 month follow-up, the patient had no recurrence of symptoms and MRA showed no recurrence of the aneurysm.

Conclusion: Stent-assisted coil embolization was effective for treating HFS caused by compression of a VA aneurysm and it might be the treatment of choice for this type of aneurysmal HFS.