Clinical observation of trigeminal neuralgia and hemifacial spasm due to vertebrobasilar dolichoectasia: A case report and literature review

Introduction. Vertebrobasilar dolichoectasia (VBD) is a rare vascular disorder characterized by abnormal elongation, tortuosity, and dilatation of the vertebral and basilar arteries. Its etiology remains incompletely understood. The reported prevalence ranges from 0.05 to 5.8 %. Clinically, VBD most often manifests asischemic stroke, compression of  the  cranial nerves and  brainstem, and,  less frequently, as intracranial hemorrhage and hydrocephalus. The prognosis depends on the clinical presentation and the degree of arterial dilatation within the vertebrobasilar system.
The aim. To present a clinical case of surgical management of symptomatic compression of the trigeminal and facial nerve roots caused by vertebrobasilar dolichoectasia using a subtemporal transtentorial approach.
Clinical case description. Patient A., a 61-year-old man, was admitted with complaints of serial episodes of pain in the left half of the face radiating to the mandible, accompanied by paroxysmal spasm of the left facial muscles. He had been taking carbamazepine with only temporary effect. Magnetic resonance imaging, computed tomography (CT), and CT angiography revealed an S-shaped course of the right vertebral artery in its intracranial segment with deviation to the left. The confl uence of the vertebral arteries was located in the region of the left cerebellopontine angle. Signs of neurovascular confl ict involving the left trigeminal and facial nerves with the displaced left vertebral artery were identifi ed. A temporo- occipital craniotomy was performed, followed by microvascular decompression of the left trigeminal and facial nerves. In the postoperative period, the neurological status showed no increase in focal defi - cits; the pain syndrome and hemifacial spasm resolved.
Discussion. Currently, there  are no  universally accepted guidelines for  the  management of  patients with VBD. Treatment is symptomatic and aims to correct cerebrovascular disturbances and compression syndromes that develop upon manifestation of VBD. In cases of neurovascular conflict, conservative management represents the first line of therapy. The role of microvascular decompression in VBD-induced neurovascular confl ct remains a subject of debate.

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