[Trigeminal neuralgia and hemifacial spasm caused by the compression of tortuous vertebro-basilar system--a case report (author's transl)].

A 63-year-old man was admitted to our clinic on August 14, 1980 with the chief compliant of left-sided intermittent facial pain. He had been suffering from twitching of the left facial muscles since 1972. During two years before admission, severe pain of the left face, starting in the left upper jaw and radiating to the left periorbital region, occurred intermittently. The pain aggravated by eating, talking and face-washing, gradually worsened and he became unable to take meals. On admission, he was alert. No sensory disturbance was seen. Muscle twitching was seen in the left orbicularis oculi, orbicularis oris and sometimes in the platysma. Mild facial palsy was recognized on the left side and other cranial nerves were intact. Computed tomogram with contrast enhancement revealed shift of the basilar artery to the left side. Markedly enlarged and tortuous vertebrobasilar system kinking at the left cerebello-pontine angle, was seen on the left vertebral angiogram. This tortuous vertebrobasilar system was presumed to be the cause of the trigeminal neuralgia and hemifacial spasm. The neuralgia disappeared after a controlled thermocoagulation of the left Gesserian ganglion, and the frequency of hemifacial spasm was reduced too. He was discharged with mild hemifacial spasm. The combination of trigeminal neuralgia and hemifacial spasm caused by direct compression of tortuous vertebro-basilar system on the nerve roots is rare. A case was reported and the literature were reviewed.