안면신경을 관통하는 동맥의 압박에 의한 반측안면경련증

초록

PURPOSE : We report a case of hemifacial spasm (HFS) associated with the anterior inferior cerebellar artery penetrating the facial nerve. MATERIALS AND METHODS : A 20-year-old man presented with left facial spasm that had persisted for 4 years. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery (AICA) was demonstrated on magnetic resonance angiography. Microvascular decompression (MVD) was performed to relieve the symptom. During surgery, penetration of the distal portion of the facial nerve root exit zone by the AICA was observed. At the penetrating site, the artery was found to compress the facial nerve and not to be mobilized. The penetrated seventh cranial nerve was longitudinal incised about 2 mm after discussion with family about the risk of the facial paresis. The compressing artery was mobilized away from the penetrating site and the decompression was completed by inserting Teflon. RESULTS : The patient showed moderate facial weakness though the facial spasm disappeared in the immediate postoperative period. The facial weakness has improved to mild degree at postoperative 4 months. CONCLUSION : Before MVD for HFS, the surgeons should be aware of the possibility of the rare complex anatomy such as penetration and compression of the facial nerve by an artery which cannot be displayed by modern image technique.