Resolution of Hemifacial Spasm after Surgical Obliteration of a Tentorial Arteriovenous Fistula: Case Report

Abstract

Abstract OBJECTIVE AND IMPORTANCE: We describe a patient with a tentorial dural arteriovenous fistula who presented with ipsilateral hemifacial spasm. CLINICAL PRESENTATION: A 50-year-old man sought treatment for left facial twitching that worsened over 6 months. Magnetic resonance imaging and catheter angiography demonstrated a left tentorial dural arteriovenous fistula. INTERVENTION: The patient underwent a retrosigmoid craniotomy and ligation of the draining vein at the site of the fistula. Intraoperative angiography showed complete obliteration of the fistula. The patient's hemifacial spasm improved significantly after the fistula was obliterated. CONCLUSION: Posterior fossa arteriovenous fistulas can present with a hemifacial spasm related to compression of the facial nerve by arterialized leptomeningeal veins. Microsurgical obliteration of the fistula can resolve the related symptoms.