• Qiang-Ping Wang, Ye Yuan, Nan-Xiang Xiong, Peng Fu, Tao Huang, Bo Yang, Jia Liu, Xi Chu, and Hong-Yang Zhao.
• Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• World Neurosurg. 2018 Dec 26.

BackgroundHemifacial spasm (HFS) is caused by vascular compression of the facial nerve. The definitive mechanism of offending vessel formation remains unclear. The aim of this study was to explore whether the anatomic and hemodynamic characteristics of the vertebrobasilar artery play a role in problematic vessel formation in HFS.MethodsImaging data of 341 patients with HFS who underwent microvascular decompression were reviewed retrospectively and compared with 360 control subjects. Hemodynamics of typical anatomic variations of the vertebral artery (VA) were analyzed using computational fluid dynamics software.ResultsAsymmetry of the left and right VAs was prevalent, and the left VA was the most dominant VA. A dominant VA was more prevalent in the HFS group than in the control group (P = 0.026). Left HFS had a significantly higher proportion of a left dominant VA, and right HFS had a significantly higher proportion of a right dominant VA (P < 0.001). Computational fluid dynamics models showed that angulation and tortuosity of vessels caused remarkable pressure difference between vascular walls of opposite sides. Dynamic clinical observations showed the mode of vessel transposition coincided with biomechanical characteristics.ConclusionsAnatomic variations and hemodynamics of the vertebrobasilar arterial system are likely to contribute to vascular compression formation in HFS.Copyright © 2018 Elsevier Inc. All rights reserved.

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