• World Neurosurg · Aug 2016

    Significance of anomalous anterior inferior cerebellar artery-posterior inferior cerebellar artery common trunk compression in microvascular decompression for hemifacial spasm.

    • Hiroshi Shimano, Akinori Kondo, Soichiro Yasuda, Hiroto Inoue, Jun Morioka, Hiroshi Miwa, Osamu Kawakami, and Kenichi Murao.
    • Department of Neurosurgery, Brain and Spine Surgery Center, Shiroyama Hospital, Osaka, Japan. Electronic address: shimano@shiroyama-hsp.or.jp.
    • World Neurosurg. 2016 Aug 1; 92: 15-22.

    BackgroundThe anterior inferior cerebellar artery-posterior inferior cerebellar artery (AICA-PICA) common trunk anomaly is reportedly one of the most common vessel variants in the posterior circulation, but reports of hemifacial spasm (HFS) associated with AICA-PICA common trunk are very rare. In the present study, we describe methods of microvascular decompression (MVD) for HFS caused by AICA-PICA common trunk compression.MethodsAmong 159 patients who underwent MVD for HFS, 16 patients had compression of the root exit zone by the AICA-PICA common trunk anomaly. The types of compression were classified into 2 groups: common trunk artery compression group and branching vessel compression group.ResultsThe common trunk artery compression group consisted of 11 patients (69%), and the branching vessel compression group consisted of 5 patients (31%). The rostral branch (feeding the original AICA territory) coursed between the seventh and eighth cranial nerves in 5 patients, and in 13 patients (81%), the offending vessel harbored perforators around the root exit zone. Among 16 patients, 14 (87.5%) required interposition of the common trunk or the branching vessel, and in 2 patients, decompression was completed by the transposition method. Fifteen patients experienced sufficient results, and 1 had severe residual spasm. Transient facial palsy developed in 2 patients. No patients encountered recurrence.ConclusionsReports concerning decompression methods of AICA-PICA common trunk anomaly are very rare. The tortuosity of the common trunk and perforators from the offending vessel make the usual repositioning of the offending artery much more difficult, and adequate decompression techniques are required for successful MVD.Copyright © 2016 Elsevier Inc. All rights reserved.

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