How I do it: simultaneous microvascular decompression for dolichoectatic vertebrobasilar artery-associated trigeminal neuralgia and hemifacial spasm

Concurrent ipsilateral trigeminal neuralgia (TN) and hemifacial spasm (HFS) are rare and typically caused by dolichoectatic vertebrobasilar compression. A 59-year-old male with refractory TN and HFS underwent preoperative MRI revealing neurovascular conflict at the root entry zones. Simultaneous microvascular decompression (MVD) of the trigeminal and facial nerves was performed via a retrosigmoid craniotomy using Teflon padding. The patient experienced immediate and sustained symptom resolution at the 18-month follow-up. Simultaneous MVD is effective for treating dual cranial nerve compression by dolichoectatic vessels.