{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:38Z","timestamp":1776096458781,"version":"3.50.1"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"10","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,9]]},"abstract":"\n BACKGROUND<\/jats:title>\n Hemifacial spasm (HFS) associated with a large fenestration of the vertebral artery (VA) is extremely rare. Here, the authors report a case of HFS caused by this vascular anomaly and discuss its embryological background and clinical implications.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A man in his 30s presented with a 7-year history of right-sided HFS. MRI demonstrated vascular compression at the root exit zone of the facial nerve. MR angiography revealed an aberrant artery running parallel to the right VA, forming a large fenestration. Three-dimensional CT angiography demonstrated a common trunk giving rise to the anterior inferior cerebellar artery and posterior inferior cerebellar artery. The offending artery was identified as the common trunk.. Microvascular decompression with real-time abnormal muscle response monitoring achieved sufficient arterial transposition, with careful preservation of the brainstem perforators. The patient experienced complete resolution of spasms postoperatively, without complications.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n A large VA fenestration may represent a persistent primitive lateral basilovertebral anastomosis. Successful surgical treatment requires a precise preoperative understanding of the complex vascular architecture and consideration of the limitations imposed by perforating branches during arterial transposition.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25777<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25777","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:12:55Z","timestamp":1773925975000},"source":"Crossref","is-referenced-by-count":0,"title":["Microvascular decompression for hemifacial spasm associated with large fenestration of the vertebral artery: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Keigo","family":"Matsumiya","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4101-1633","authenticated-orcid":true,"given":"Shigeki","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinichi","family":"Origuchi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4191-0082","authenticated-orcid":true,"given":"Daiki","family":"Yokoyama","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4400-3006","authenticated-orcid":true,"given":"Kentaro","family":"Horiguchi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iwao","family":"Yamakami","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sousen Hospital, Chiba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5689-3416","authenticated-orcid":true,"given":"Yoshinori","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5","key":"bib1","series-title":"J Neurol Neurosurg Psychiatry","first-page":"465","article-title":"Hemifacial spasm: treatment by posterior fossa surgery","volume":"46","author":"Jannetta","year":"1983","unstructured":"Jannetta PJ.Hemifacial spasm: treatment by posterior fossa surgery. J Neurol Neurosurg Psychiatry. 1983;46(5):465-466. doi:10.1136\/jnnp.46.5.465"},{"issue":"3","key":"bib2","series-title":"J Neurosurg","first-page":"321","article-title":"Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients","volume":"47","author":"Jannetta","year":"1977","unstructured":"Jannetta PJAbbasy MMaroon JCRamos FMAlbin MS.Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg. 1977;47(3):321-328. doi:10.3171\/jns.1977.47.3.0321"},{"issue":"2","key":"bib3","series-title":"Neurosurg Rev","first-page":"311","article-title":"Continuous intraoperative monitoring of abnormal muscle response in microvascular decompression for hemifacial spasm; a real-time navigator for complete relief","volume":"37","author":"Hirono","year":"2014","unstructured":"Hirono SYamakami ISato MContinuous intraoperative monitoring of abnormal muscle response in microvascular decompression for hemifacial spasm; a real-time navigator for complete relief. Neurosurg Rev. 2014;37(2):311-320. doi:10.1007\/s10143-013-0507-5"},{"key":"bib4","series-title":"NMC Case Rep J","first-page":"69","article-title":"Persistence of primitive lateral basilovertebral anastomosis with a ruptured posterior inferior cerebellar artery aneurysm: a case report","volume":"9","author":"Ota","year":"2022","unstructured":"Ota TDofuku SSato M.Persistence of primitive lateral basilovertebral anastomosis with a ruptured posterior inferior cerebellar artery aneurysm: a case report. NMC Case Rep J. 2022;9:69-72. doi:10.2176\/jns-nmc.2021-0386"},{"issue":"11","key":"bib5","series-title":"Anat Rec (Hoboken)","first-page":"2025","article-title":"The role of the primitive lateral basilovertebral anastomosis of Padget in variations of the vertebrobasilar arterial system","volume":"300","author":"Gregg","year":"2017","unstructured":"Gregg LGailloud P.The role of the primitive lateral basilovertebral anastomosis of Padget in variations of the vertebrobasilar arterial system. 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Contr Embryol Carneg Instn. 1948;32:205-261."},{"issue":"1","key":"bib16","series-title":"J Anat","first-page":"25","article-title":"The development of the hindbrain arteries in the rat","volume":"91","author":"Moffat","year":"1957","unstructured":"Moffat DB.The development of the hindbrain arteries in the rat. J Anat. 1957;91(1):25-39."},{"issue":"3","key":"bib17","series-title":"Neurochirurgie","first-page":"101517","article-title":"Embryology of the vertebral artery and variants of the adult","volume":"70","author":"Bonasia","year":"2024","unstructured":"Bonasia SDi Caterino FRobert T.Embryology of the vertebral artery and variants of the adult. 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World Neurosurg. 2016;92:15-22. doi:10.1016\/j.wneu.2016.04.100"},{"issue":"11","key":"bib21","series-title":"Acta Neurochir (Wien)","first-page":"2945","article-title":"Common trunk anomaly of the anterior and posterior inferior cerebellar artery in hemifacial spasm","volume":"164","author":"Goto","year":"2022","unstructured":"Goto YInoue T.Common trunk anomaly of the anterior and posterior inferior cerebellar artery in hemifacial spasm. Acta Neurochir (Wien). 2022;164(11):2945-2951. doi:10.1007\/s00701-022-05230-w"},{"issue":"5","key":"bib1","series-title":"J Neurol Neurosurg Psychiatry","first-page":"465","article-title":"Hemifacial spasm: treatment by posterior fossa surgery","volume":"46","author":"Jannetta","year":"1983","unstructured":"Jannetta PJ.Hemifacial spasm: treatment by posterior fossa surgery. J Neurol Neurosurg Psychiatry. 1983;46(5):465-466. doi:10.1136\/jnnp.46.5.465"},{"issue":"3","key":"bib2","series-title":"J Neurosurg","first-page":"321","article-title":"Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients","volume":"47","author":"Jannetta","year":"1977","unstructured":"Jannetta PJAbbasy MMaroon JCRamos FMAlbin MS.Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. 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