• Yu Yamamoto, Hirokuni Hashikata, Hiroki Toda, and Koichi Iwasaki.
• Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Japan.
• World Neurosurg. 2019 Feb 1; 122: 491-494.

BackgroundThe course of the anterior inferior cerebellar artery (AICA) in the cerebellopontine angle may affect the technical options in microvascular decompression surgery for hemifacial spasm. A complex relationship between the AICA and the nervus intermedius has rarely been discussed in patients with hemifacial spasms.Case DescriptionA 74-year-old woman presented with left facial spasms for 8 years. Intraoperative endoscopic observation confirmed that the left nervus intermedius crossed over the left AICA and limited its mobilization from the root exit zone (REZ) of the left facial nerve. Nervus intermedius section enabled mobilization of the AICA to decompress the facial nerve REZ. Her hemifacial spasm was resolved completely after the surgery with no significant complication.ConclusionsThe AICA may be found between the nervus intermedius and the facial nerve proper in patients with hemifacial spasm. Endoscope can visualize the relationship between the AICA and the nervus intermedius. Nervus intermedius section is a useful option in case that the nervus intermedius limits adequate mobilization of the AICA from the facial nerve REZ.Copyright © 2018 Elsevier Inc. All rights reserved.

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