A Case of Trigeminal Neuralgia with Hemifacial Spasm – Double Mvd – A Surgical Cure

Abstract

Trigeminal neuralgia (TN) and hemifacial spasm (HFS) are cranial nerve hyperactive dysfunction syndromes most commonly caused by neurovascular compression. The simultaneous occurrence of TN with ipsilateral HFS—historically termed painful tic convulsif—is rare and often associated with dual neurovascular conflict. We report the case of a 62-year-old woman with a 15-year history of refractory right-sided TN accompanied by progressive ipsilateral HFS. MRI revealed vascular compression of both the trigeminal nerve and the facial–vestibulocochlear nerve complex. The patient underwent right retromastoid suboccipital craniectomy with double microvascular decompression (MVD). Intraoperatively, the anterior inferior cerebellar artery (AICA) and superior cerebellar artery (SCA) were identified as offending vessels. Successful decompression produced immediate and complete resolution of both facial pain and spasms, with no postoperative deficits. This case highlights the importance of recognizing combined neurovascular compression syndromes and supports early surgical intervention as a definitive, highly effective treatment. Double MVD offers durable symptom relief and can significantly improve patient quality of life.