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Combined hemifacial spasm and progressive hearing loss treated by MVD of AICA crossing between VII/VIII nerves
EANS Academy. Matos D. Sep 26, 2019; 276181; EP07024
Dr. Daniela Matos
Dr. Daniela Matos

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Abstract
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Primary Hemifacial Spasm (HFS) is a relatively rare although often debilitating condition, characterized by involuntary tonic and/or clonic contractions of the facial-innervated muscles.
Microvascular decompression (MVD) is an effective and generally safe treatment for HFS, for which medical treament is frequently limited.
Nerve compression is usually on the root exit zone and caused by a branch of the vertebrobasilar system (most commonly AICA or PICA).
We present a rare case of combined hemifacial spasm and progressive high-frequency hearing loss, caused by neurovascular compression from a AICA loop, in which MVD greatly improved
HFS and interrupted the hearing loss.
A 40-year old male presented with permanent rigth-side HFS, refractory to medical treatment, combined with ipsilateral progressive neurosensorial hearing loss and vestibular symptoms.
MRI disclosed an AICA loop adjacent to the median portion of the cisternal VII/VIII complex and he was proposed to MVD.
A keyhole retrosigmoidal approach was performed, only to find that the AICA was crossing through the VII and VIII nerves, rendering complete decompression unfeasible.
Nevertheless, the nerves were carefully dissected from the intervening artery and very small pledgets of teflon were introduced between the nerves and the AICA, in the areas of maximal contact.
Post-operatively, HFS resolved, with hearing function deteriorating temporarily, to recover after 6 months.
This case combines several rare circumstances, namely the association of pré-operative hearing loss to HFS, more peripheral nerve compression and AICA crossing of the nerve complex.
Nonetheless, the case illustrates that MDV, even in difficult surgical scenarios, can be highly effective and a safe procedure.
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