A Rare Combined Trigeminal Neuralgia with Hemifacial Spasm in a 78-Year-Old Male Patient

Abstract

Background: Combined trigeminal neuralgia (TN) with hemifacial spasm (HFS) is a rare pathological condition. Microvascular decompression (MVD) can be used to treat combined TN and HFS in a single procedure with good outcome, mild complication, and low recurrence rate. Case Presentation: A 78-year-old male patient has presented with stabbing-like pain over the right side forehead and upper cheek since 2014. He also presented with twitching on the right eyelid and forehead since 2016. He already taken a medication with anticonvulsant but the pain does not decrease at all. Physical examination revealed an increasing pain to light touch over the ophthalmic and maxillary distribution of right trigeminal nerve (N.V). No abnormalities found in the facial nerve (N.VII). Magnetic resonance examination (MRI) examination revealed compression of right N.V by right superior cerebellar artery (SCA) and no compression found in the N.VII. This patient is treated with MVD and we found out a compression of right N.V by right SCA and N.VII from right anterior inferior cerebellar artery (AICA). Postoperatively, the symptoms resolved with a transient hypoesthesia and no recurrence after 1 year follow up. Conclusion:Combined TN and HFS is a rare finding and seldom addressed. This pathological condition is found to be caused by progressive atherosclerotic changes in elderly populations that lead to elongation of blood vessels and contact the nearby nerve structure. MVD can be done safely in elderly patients with a good outcome and a mild transient complication such as hypoesthesia and low recurrence rate of symptoms.