Improvement of Hemifacial Spasm after Stent-assisted Coil Embolization for Ipsilateral Vertebral Artery Dissecting Aneurysm

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  • MIYAZAKI Yuko
    Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
  • MATSUBARA Shunji
    Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
  • ISHIHARA Manabu
    Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
  • MINAMI Yukari Ogawa
    Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
  • KINOSHITA Keita
    Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
  • TAKAI Hiroki
    Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
  • HIRAI Satoshi
    Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
  • HARA Keijirou
    Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
  • YAGI Kenji
    Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan
  • UNO Masaaki
    Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan

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Abstract

<p>Microvascular decompression (MVD) is the gold standard in the treatment of hemifacial spasm (HFS), and endovascular surgery has been described as a treatment only for aneurysm-induced HFS in several previous cases. We describe symptomatic HFS caused by a normal vertebral artery (VA) trunk adjacent to the ipsilateral dissecting VA aneurysm completely cured after stent-assisted coil embolization. A 52-year-old man presented with a 2-month history of gradually worsening left HFS. Magnetic resonance imaging (MRI) and cerebral angiography revealed a dissecting VA aneurysm on the left side. Based on the findings from preoperative MRI, not the aneurysmal dome itself, but the VA trunk just distal to the aneurysmal dome was considered likely to be compressing the root exit zone (REZ) of the facial nerve. Stent-assisted coil embolization was conducted for the VA aneurysm, and the stent was deployed to cover the wide neck of the aneurysm and offending zone of the VA trunk simultaneously. HFS started to show improvement just after the procedure and complete disappearance within 1 year. HFS was completely resolved by stenting of the offending artery. Stents may show efficacy for “intra-arterial decompression” by reducing pulsatility against the REZ of the facial nerve due to the thickness and rigidity of the stent metal and delayed endothelialization.</p>

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