[A surgical case of hemifacial spasm caused by a tortuous, enlarged, and calcified vertebral artery].

Microvascular decompression (MVD) is an established procedure to treat hemifacial spasm and trigeminal neuralgia. However, this cannot be done in some cases in which ecstatic vertebrobasilar arteries are involved. In these instances, alternative techniques must be used. We encountered a patient with hemifacial spasm caused by a calcified, enlarged, and tortuous vertebral artery. To obtain safe and certain neurovascular decompression of the facial nerve, the tortuous and calcified vertebral artery was surgically repositioned by placing layers of Teflon felt at two regions between the brain stem and the artery. After surgery hemifacial spasm completely disappeared. This method is thought to be a useful option for the treatment of hemifacial spasm caused by a tortuous, enlarged, or calcified vertebral artery.