ArticleJournal of neurosurgery. Case lessons2026
Flow diversion for vertebral artery fusiform/dissecting aneurysm-related hemifacial spasm: illustrative cases.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHemifacial spasm (HFS) results from pulsatile neurovascular conflict at the facial nerve root exit zone (REZ) and is treated with microvascular decompression (MVD). Aneurysm-related HFS is rare, and evidence for flow diversion (FD) is limited. OBSERVATIONS: Two women with vertebral artery (VA) fusiform/dissecting aneurysms presented with ipsilateral HFS and underwent flow diverter treatment. Case 1 had bilateral fusiform VA aneurysms; the symptomatic left V4 lesion compressed the REZ without branch incorporation. Overlapping Pipeline Shield devices achieved complete occlusion and durable HFS resolution. Case 2 had a left V4 dissecting aneurysm incorporating the posterior inferior cerebellar artery (PICA). A FRED flow diverter reduced aneurysmal filling and transiently improved HFS, but residual filling persisted mainly around the PICA origin and symptoms recurred. Nineteen months later, lateral suboccipital MVD transposed the VA-PICA complex away from the REZ with sustained control. LESSONS: FD can cure aneurysm-related HFS without craniotomy when complete exclusion is feasible and no critical branch is incorporated. In branch-bearing lesions, incomplete occlusion and persistent contact may cause recurrence; structured follow-up and readiness for staged MVD are essential. Given rupture risk, staged MVD after aneurysm stabilization may be considered in selected cases when symptoms persist or recur. https://thejns.org/doi/10.3171/CASE26430.
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