Venous Offenders in Hemifacial Spasm: A Missing Piece in the Hemodynamic Puzzle.

This letter to the editor comments on a recent computational fluid dynamics study by You et al. on hemodynamic features of offending arteries in hemifacial spasm (HFS). While the original study provides valuable insights into arterial compression, it omits venous offenders and multi-vessel compression scenarios. Drawing on clinical cases and surgical evidence, this letter highlights the independent role of veins (e.g., the vein of the middle cerebellar peduncle) and the complexity of vertebral artery involvement. It argues that future CFD studies should include venous etiologies and multi-vessel configurations to improve diagnostic accuracy and surgical planning. The hemodynamic differences between arterial and venous compression are discussed, and the potential utility of parameters such as TAWSSR for venous offenders is proposed.