Anterior inferior cerebellar artery (AICA) compression is a common cause of hemifacial spasm (HFS). Endoscopic-assisted microvascular decompression (eMVD) offers several advantages, including minimal invasiveness, wide viewing angles, and clear visualization. The surgical procedure was performed under a four-step endoscopic technique. Step 1: A 0° endoscope was used to dissect the cerebellopontine cistern and release cerebrospinal fluid for decompression. Step 2: A 30° endoscope was employed to dissect the arachnoid around the facial nerve and expose the root exit zone (REZ). Step 3: The AICA was identified, carefully dissected, and transposed away from the REZ. Step 4: Adequate decompression and hemostasis were confirmed. The four-step endoscopic approach can achieve effective decompression in cases of HFS caused by AICA compression, providing favorable surgical outcomes.

Trigeminal neuralgia (TN) is a debilitating condition often associated with multiple sclerosis (MS), in which the presence of demyelinating plaques in the pons can impact the trigeminal nerve. Microvascular decompression (MVD) is the gold-standard surgical treatment for classic TN but is traditionally contraindicated in TN-MS patients due to limited efficacy and concerns over neurovascular compression as the sole etiology. This systematic review aimed to evaluate the outcomes of MVD in TN-MS patients, focusing on pain relief and complications. A systematic search of the PubMed, Embase, Scopus, and Web of Science databases was conducted in June 2024, adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies reporting on MVD outcomes in TN-MS patients were included. Data on demographics, clinical characteristics, surgical outcomes, and complications were extracted. The primary outcome was long-term pain-free status (Barrow Neurological Institute [BNI] score of I) at the final follow-up. A meta-analysis of proportions was performed using a random-effects model. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies tool. From 523 unique records, 30 studies were included, consisting of 429 TN-MS patients treated with MVD, with 265 unique patients. Neurovascular compression was identified in 96.6% of the patients. The pooled success rate of MVD, defined as achieving a BNI score of I, was 30.2% (95% CI 24.2%-36.9%). Heterogeneity was low (I2 = 0%-25%) across analyses. The most common complication reported after MVD was transient facial numbness. Publication bias was not significant in the included studies. MVD is less effective in TN-MS patients than in those with classic TN, with approximately 30% achieving long-term pain-free outcomes. However, MVD may still offer meaningful relief, particularly in patients with neurovascular compression. Given these findings, MVD should not be categorically excluded as a treatment option for TN-MS. Further prospective studies are needed to refine patient selection and optimize outcomes.

A clinical nomogram for predicting recurrence after percutaneous radiofrequency ablation in the management of primary hemifacial spasm.

Quantitative intraoperative lateral spread response amplitudes in hemifacial Spasm: Associations with vascular burden.

The most effective treatment for a typical trigeminal neuralgia is microvascular decompression of the trigeminal nerve. An approximately 3-5cm in diameter retrosigmoid craniotomy with an approximately 12-14cm long skin incision is considered the standard approach.Modern neurosurgery strives for minimally invasive surgical approaches, which in turn reduces both intraoperative and postoperative complications. The use of minimally invasive approaches in skull base neurosurgery and, in particular, in microvascular decompression of the trigeminal nerve can reduce the risk of complications such as cranial nerve and cerebellar injuries, cerebrospinal fluid (CSF) fistula and sinus thrombosis. The minimally invasive approach also provides a good cosmetic effect. We conducted a retrospective study of 52 consecutive patients with trigeminal neuralgia. All patients underwent microvascular decompression of the trigeminal nerve via a minimally invasive retrosigmoid approach. The data were compared with date those of the largest published studies.The findings obtained in this patient population were consistent with those of large studies. Treatment efficacy was also in line, with 98.1% of patients showing improved symptoms of trigeminal neuralgia. No major permanent complications were observed. Transient complications included ipsilateral facial hypoesthesia (40.4%), mild facial nerve paresis (7.3%), hypoacusis (3.8%), and trochlear nerve paresis (1.9%), all resolving within three months post-surgery. CONCLUSION: Minimally invasive retrosigmoid craniotomy result in as good surgical outcomes as standard craniotomy. The reduced size of a surgical approach does not affect the treatment efficacy.The reduced craniotomy size helps avoid traumatization of anatomical structures in the surgical field, reduce possible complications, and shorten postoperative follow-up.

Cervical plexus block (CPB) provides postoperative analgesia and reduces postoperative nausea and vomiting (PONV), which are important for improving the quality of recovery after head and neck surgical procedures. This randomized controlled trial investigated the effect of superficial CPB on early postoperative quality of recovery in patients undergoing microvascular decompression (MVD). Patients undergoing MVD for trigeminal neuralgia and hemifacial spasm were randomly assigned to receive superficial CPB or not (n = 30 per group). Ultrasound-guided superficial CPB was performed with 10cc of 0.5% ropivacaine before surgery. The primary outcome measure was the Korean version of the 15-item Quality of Recovery (QoR-15K) score on postoperative day 1. The secondary outcome measures included postoperative pain scores, the incidence of PONV, and perioperative inflammatory cytokine levels. The QoR-15K score on postoperative day 1 did not show a significant difference (94.5 [68.0-116.0] vs. 80.5 [51.5-100.8], P = 0.077) between the 2 groups. Perioperative QoR-15K scores also showed no significant time × group effect (P = 0.324). Postoperative pain scores did not differ between the 2 groups. The incidence of PONV was significantly reduced in the superficial CPB group at 6 (P = 0.001) and 12 (P < 0.001) hours postoperatively. Perioperative inflammatory cytokine levels showed no differences between the 2 groups. Superficial CPB did not improve early postoperative QoR in patients undergoing MVD. However, it reduced the incidence of PONV during the early postoperative period, which could potentially enhance patient comfort and satisfaction.

Gamma Knife radiosurgery (GKRS) is an established treatment for refractory trigeminal neuralgia, however, predictors of pain relief following treatment remain unclear. We aimed to identify the factors associated with pain relief after the index GKRS session. We retrospectively analyzed 204 patients with trigeminal neuralgia treated with GKRS between 1998 and 2023 (mean age 65.2 years, 68.5% female). Patient variables (pretreatment Roswell Park and Barrow Neurological Institute pain scores, symptom duration, prior therapies, multiple sclerosis status), MRI metrics (neurovascular contact and trigeminal nerve dimensions), and radiosurgery parameters (isocenter location and radiation dose, including biologically effective dose [BED]) were assessed. Responders were defined as BNI<IIIb or RPS<3. At last follow-up (median 20 months, range 6 months to 26 years), 57.3% of patients achieved pain relief. At ≥3-year follow-up, 74.1% of patients maintained adequate pain relief. Multiple sclerosis and prior interventions were associated with lower response rates: MS patients had 27.7% response vs 57.7% without MS (p=0.008), and prior microvascular decompression (MVD) had 34.4% vs 62.7% without prior MVD (p=0.005). GKRS as first-line therapy yielded better outcomes than when used after other treatments (63.9% vs 38.9%, p=0.045). Responders had a smaller trigeminal nerve (mean diameter 3.04 vs 3.42 mm, p=0.007) and a greater isocenter to brainstem orthogonal distance (4.2 vs 3.5 mm, p=0.02). A BED ≥ 2000 Gy was associated with higher response rate (75.8% vs 48.8%, p=0.006). In multivariate analysis, absence of MS, no prior MVD, smaller nerve diameter, and BED ≥ 2000 Gy independently predicted pain relief. Non-modifiable factors that affected response included absence of MS and smaller trigeminal nerve size. Modifiable factors that were associated with higher response rates included no prior MVD, placing the isocenter farther from the brainstem surface, and BED≥ 2000 Gy. These findings support individualized treatment sequencing and GKRS planning to optimize GKRS outcomes in trigeminal neuralgia.

Introduction: Trigeminal neuralgia (TN) is characterized by severe, shock-like facial pain, often triggered by light stimuli. While pharmacological therapy (e.g., Carbamazepine or Oxcarbazepine) is effective for most patients, a significant proportion develop refractory pain requiring surgical intervention. Microvascular decompression (MVD) is considered the gold-standard etiological treatment, offering high long-term pain relief.1 Recent studies confirm its safety and effectiveness, especially in patients with well-defined neurovascular contact.2 Minimally invasive alternatives, such as percutaneous radiofrequency rhizotomy and stereotactic radiosurgery, are valid options in selected cases.3Clinical description: A 64-year-old female presented with a 5-year history of right-sided facial pain, described as electric shock-like episodes affecting the maxillary and mandibular branches, with progressive worsening. Prior pharmacologic treatment included carbamazepine, oxcarbazepine, and baclofen, with only partial relief and significant side effects. Brain MRI revealed vascular contact between the superior cerebellar artery and the right trigeminal nerve root. Given the pain refractoriness and clear compressive etiology, MVD was indicated. Surgery was performed via a retrosigmoid approach with vascular dissection and interposition of a Teflon patch. The patient had no new neurological deficits and reported immediate and complete pain relief. At 6-month follow-up, she remained pain-free, with good control on low-dose carbamazepine monotherapy. She reported marked improvement in quality of life, resuming domestic and social activities without limitations or adverse effects.Discussion: Classical TN with neurovascular conflict is the most responsive subtype to MVD. Prospective studies show pain relief in up to 86% of cases, especially in patients with nerve morphological changes.2 A retrospective study showed that after 43 months, 83% achieved substantial relief, often with reduced medication.3 Compared to percutaneous techniques, MVD offers lower recurrence and fewer sensory complications.³ Proper patient selection and multidisciplinary assessment are key.Conclusions: MVD remains a safe, effective option for refractory TN with neurovascular conflict. This case illustrates the benefits of early surgical intervention, leading to pain remission, monotherapy, and significant quality-of-life gains.

Introduction: The efficacy of neuroimaging for identification of the pure venous neurovascular conflict (NVC) in cases of trigeminal neuralgia (TN) is low. Possible identification of additional radiological characteristics that may support clinical diagnosis and help to determine indications for microvascular decompression (MVD) in such cases seems important.Method: The objective of our retrospective study1 was assessment of the imaging characteristics that may support the clinical diagnosis of TN caused by pure venous conflict. Preoperative axial constructive interference in steady state (CISS) images were analyzed in 30 patients with TN, and length, width, T2 hyperintensity, and shape of the cisternal segment of trigeminal nerve (CN V), as well as sizes of the trigeminal-pontine angle, trigeminal-petrous angle, and cerebellopontine cistern were evaluated on both sides. In all patients pure venous NVC as a cause of TN was confirmed during subsequent MVD performed between April 2007 and December 2019. Two-tailed paired t test and chi-square test were used for comparison of evaluated variables as appropriate.Result: On the affected side, the length of CN V was significantly shorter (mean 7.9 mm vs. 9.0 mm, P = 0.0249), whereas its width in midportion (mean 4.0 mm vs. 3.5 mm, P = 0.0022) and the size of the trigeminal-pontine angle (mean 55.30 vs. 48.80, P = 0.0052) were significantly larger. Other evaluated characteristics did not differ significantly between affected and nonaffected sides. Statistically significant odds ratio (OR) for the association with affected side was revealed for shorter length (OR 10.5, P = 0.0319) and larger width (OR 8.8, P = 0.0487) of CN V; the presence of either of these parameters (i.e., shorter and/or thicker CN V) provided the highest discriminative value (OR 19.3, P = 0.0063).Discussion: In patients with TN the length of CN V on the affected side is usually shorter compared with the nonaffected side,2,3 which well corresponds to results of this study. However, our data showed significantly greater trigeminal-pontine angle and larger width of CN V on the side of facial pain, which contravene previous reports.2,3 Of note, all former relevant investigations were mostly done in cases of NVC caused by compressing artery, which is clearly different from our series. It can be speculated that different types of NVC result in divergent changes of CN V and that in contrast to arterial compression, which may be due to the sharper trigeminal-pontine angle and frequently lead to the nerve root atrophy, venous conflict often causes stretching and/or local edema of CN V, which may appear on MRI as an increase of its width.Conclusions: Identification of shorter and/or thicker CN V on the affected side in patients with TN without an obvious offending vessel on MRI may suggest the presence of pure venous conflict and help with decision making about MVD.

Introduction: Microvascular decompression (MVD) is the gold standard treatment for hemifacial spasm (HFS), but it carries a risk of auditory morbidity, primarily due to lateral traction on the eighth cranial nerve during exposure of the facial nerve. This study aimed to: (1) assess the incidence and mechanisms of hearing loss during MVD for HFS; (2) identify critical intraoperative changes in brainstem auditory evoked potentials (BAEPs) that predict postoperative outcomes; and (3) define practical intraoperative warning thresholds.Method: We retrospectively analyzed 100 patients undergoing MVD for HFS, including 84 with detailed intraoperative BAEP recordings and 34 earlier cases. BAEPs were continuously monitored, focusing on Wave I–V interpeak latency, Wave V latency shifts, and amplitude changes. Pre- and postoperative auditory function was evaluated using pure tone average (PTA). Correlations between intraoperative changes and hearing outcomes were analyzed to identify risk thresholds.Result: Hearing was preserved in 88% of monitored patients. Hearing loss occurred in 9.5%, and complete deafness in 2.3%. Wave V latency delay was the most sensitive intraoperative marker. Mean delay was 0.61 ms (±0.36) in patients without hearing loss, and 1.05 ms (±0.64) in those with hearing decline. Wave V abolition was associated with permanent deafness. Most BAEP changes occurred during cerebellar retraction. Earlier cases without systematic monitoring showed a higher deafness rate (3/7) than later ones (2/93).Discussion: BAEP monitoring reduces the risk of hearing loss by detecting reversible changes during MVD. We propose three intraoperative warning thresholds: • 0.4 ms Wave V delay – “watching” • 0.6 ms – “warning” • 1.0 ms or BAEP loss – “critical” These thresholds help prevent irreversible auditory damage in functional neurosurgery.

Trigeminocerebellar artery (TCA) is known as a causable artery of trigeminal neuralgia (TN) because this anomalous artery has unfavorable anatomic features to perform the microvascular decompression. We aimed to clarify the long-term outcomes of TN caused by TCA and demonstrate surgical concepts with various techniques for its treatment. Patients who underwent surgeries for TN by TCA were retrospectively reviewed with intraoperative findings, surgical techniques, and long-term outcomes were investigated. Surgical treatments of TN were performed on 146 patients, and 13 patients (9%) had symptoms owing to TCA. Patients in TCA group (average age: 59.1 years; sex [male:female = 3:10]; affected side [right:left = 10:3], affected area [V2: 8; V3: 1; V1 + 2: 3; and V2 + 3: 1]) had TCAs with the following anatomic characteristics: penetration of the trigeminal nerve (8 patients; 62%) and presence of several perforators (all patients) (median: 3 branches). Various surgical techniques (transposition: 5 patients [38.5%]; arterial reshaping: 1 patient [12.5%]; arterial reshaping + interposition: 2 patients [25.0%]; and partial sensory rhizotomy + transposition: 5 patients [62.5%]) were applied as required. Although 1 patient required postoperative oral medication, the other 12 patients (92%) experienced complete symptom resolution immediately after the surgery, and no recurrence was observed during the median follow-up period of 72 months. This study among 146 patients with TN observed 13 patients (9%) caused by TCA and confirmed the favorable long-term outcomes in 12 patients (92%) with complete resolution of symptom without recurrence. As TCA has disadvantageous anatomic structures to be separated from trigeminal nerve, to treat TN caused by TCA, contemporary standard techniques are insufficient at times and various case-by-case surgical techniques must be required.

BackgroundThe application value of intraoperative lateral spreading response (LSR) during microvascular decompression (MVD) is always disputed. The current study aimed to explore the predictive value of intraoperative LSR monitoring for the long-term outcome in patients with primary hemifacial spasm (pHFS).MethodsThe data from 312 pHFS patients were retrospectively reviewed. The zygomatic LSR (ZYG-LSR) and mandibular LSR (MAN-LSR) monitoring were performed during surgery. The correlations of ZYG-LSR and MAN-LSR disappearances with patients’ long-term outcomes (one year after surgery) were retrospectively investigated. Consequently, binary logistic regression analysis was applied to explore their predictive value. Finally, the implications of their combined utilization for predicting the long-term outcome were explored.ResultsPatients with either persistent ZYG-LSR or MAN-LSR exhibited a higher incidence of spasms one year after surgery (p < 0.001). Persistent ZYG-LSR (odds ratio 7.721, p < 0.001) and MAN-LSR (odds ratio 10.729, p < 0.001) were both identified as independent predictive factors for an unfavorable long-term outcome. Taking both ZYG-LSR and MAN-LSR into consideration, patients with simultaneously disappeared two waves had the highest long-term recovery rate (97.2%), followed by patients with either persisted wave (76.5%) and patients with simultaneously persisted two waves (27.3%). The differences among all pairwise comparisons were statistically significant (p < 0.001 for all).ConclusionThe current study confirmed the application value of intraoperative LSR monitoring during MVD in patients with pHFS. In addition, the clinical significance of two-branch LSR monitoring was also described. The findings can provide important insights for optimizing the application of intraoperative LSR monitoring in clinical practice.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40001-025-03293-w.

Many patients with hemifacial spasm (HFS) undergo botulinum toxin injections (BTI) as an initial treatment and later undergo microvascular decompression (MVD), typically a more definitive treatment. However, in some cases, spasms recur after MVD, and patients may benefit from redo MVD. The impact of preoperative BTI on spasm freedom after redo MVD remains unclear. This study aims to further investigate this relationship and determine factors which affect redo MVD outcomes. In a retrospective cohort study, an adjusted ordinal logistic regression model was used to identify factors associated with spasm freedom after redo MVD of the facial nerve, including age, sex, laterality, preoperative BTI, number of prior MVDs, type of neurovascular conflict, and offending vessel. Of the 102 patients with HFS who underwent redo MVD with a minimum of 2 years of follow-up (mean 6.8 years), 75 achieved complete spasm freedom (73.5%) and 12 (11.8%) experienced >75% spasm relief. There were no significant associations between MVD outcomes and age (P = .32), sex (P = .93), laterality (P = .24), and preoperative BTI (P = .29). Notably, multiple prior MVDs predicted poorer response (P = .011). The presence of posterior inferior cerebellar artery (P = .010) and neurovascular compression (P = .00008) were associated with better spasm outcomes. While patients with a history of multiple prior MVDs tended to benefit less from redo MVD, the number of preoperative BTI was not associated with spasm freedom after the procedure. These findings suggest that, in cases of spasm recurrence after MVD, HFS can be managed by BTI without compromising the effectiveness of subsequent redo MVD.

Background: Trigeminal neuralgia (TN) is a debilitating facial pain disorder commonly associated with neurovascular compression (NVC), frequent radiological finding, often asymptomatic and insufficient for diagnosis without clinical correlation. We present a case in which Gamma Knife radiosurgery (GKRS) was performed for presumed TN based on incidental imaging findings, leading to the development of trigeminal neuropathy. According to the International Classification of Headache Disorders (ICHD-3), secondary trigeminal neuropathy refers to facial pain or sensory deficits resulting from a structural lesion, commonly due to tumors, multiple sclerosis, or iatrogenic injury. Methods: A 50-year-old male with a history of two self-limited episodes of right facial nerve palsy underwent brain MRI, which incidentally showed vascular contact with the right trigeminal nerve. Despite the absence of classic TN symptoms, the patient underwent GKRS in March 2024. By July 2024, the patient developed progressive right-sided trigeminal hypoesthesia and dysesthesia of ophthalmic and maxillary divisions. By the end of 2024, he reported paroxysmal, electric shock-like pain (NRS 10/10) in the right frontal, periorbital, and genian regions, up to five times daily. Brain MRI in December 2024 demonstrated a small enhancing lesion in the cisternal segment of the right trigeminal nerve and mild T2-FLAIR hyperintensity near the root entryzone. Pharmacologic treatment provided no significant benefit. Results: The absence of prior symptoms, the temporal association of symptom onset with the procedure, and the lack of alternative neuroimaging findings strongly support an iatrogenic etiology. Secondary causes - including neoplasms, multiple sclerosis, neuroborreliosis, neurosarcoidosis, and varicella-zoster virus reactivation - were excluded by clinical and laboratory evaluation. Conclusion: This case underscores the potential harm of relying solely on imaging findings such as NVC in the absence of clinical features. GKRS should be reserved for patients with clear symptomatic TN who are refractory to medical therapy and not suitable candidates for microvascular decompression. The patient’s clinical course is consistent with a radiosurgery-induced trigeminal neuropathy, fulfilling the criteria for post-traumatic painful trigeminal neuropathy (ICHD-3 code 13.1.2.3). This report highlights the importance of thorough clinical evaluation in facial pain syndromes. Overreliance on radiologic findings without adequate clinical correlation may result in misdiagnosis and unnecessary, potentially harmful interventions.

BACKGROUND Percutaneous procedures including radiofrequency (RF) and glycerol rhizotomy and percutaneous ballon compression are safe and effective alternatives to microvascular decompression (MVD) for refractory trigeminal neuralgia. Although minimally invasive, these methods cause direct injury to the trigeminal ganglion and nerves. We report the largest series of a novel treatment for refractory trigeminal neuralgia with percutaneous fluoroscopy‐guided trigeminal ganglion blockade with bupivacaine lidocaine. Methods We included patients with medially refractory trigeminal neuralgia. Data on patient demographic, location and severity of the trigeminal neuralgia, block technique (electromyography [EMG] guided with blink reflex, 3D software guided and fluorography guided), type and dose of lidocaine, cerebrospinal fluid return, complications, time period to return to baseline severity, overall months of follow‐up, the need for another procedure, time period for another procedure and current pain scale was collected. Results Thirteen patients with refractory trigeminal neuralgia who underwent fluoroscopy‐guided lidocaine blockade at University of Missouri from September 2020 to January 2024 were analyzed; four underwent EMG‐guided, four 3D software‐guided and remainder underwent fluoroscopy‐guided blockade. Two patients were loss to follow‐up. In the remaining 11 patients, three patients had no pain resolution; two had relief after MVD and was one considering MVD at the last follow‐up. One patient had resolution with Botox injection, initiated with recurrence one month later. Seven (66%) patients had long‐term resolution ranging from 3 to 21 months. Conclusion Bupivacaine lidocaine blockade may provide complete pain relief in medically refractory trigeminal neuralgia and may be considered prior to RF and glycerol rhizotomy.

Hemifacial spasm in the Middle East: Insights from a high-volume tertiary care center.

Abstract Background Trigeminal neuralgia is also coined with tic douloureux: a syndrome characterized by paroxysmal attacks of pain. Via myelinated A-fibers, it is caused by nonnociceptive stimuli such as yawning, chewing, light touch, and other transmitted stimuli. Trigeminal neuralgia may be classical or symptomatic. Aim of the Work We aimed by our study to evaluate the effectiveness and the safety of the endoscopic assisted microvascular decompression as a technique in management of patients with primary trigeminal neuralgia regarding pain control, recurrence rate, procedure related complications. Patients and Methods Prospective observational analytical cohort study that will include 40 consecutive patients divided equally into 2 groups of patients one with endoscopic assisted technique and the other with purely microscopic technique. Supervisors and experts will evaluate patients and do the procedures in Neurosurgery department, Ain Shams University Hospitals from September 2021 to September 2024. Results Among the 20 patients of EA-MVD group, a total of 39 sites of compression were observed, divided into those that were detected by microscope and those that were not visible under microscope and detected by the endoscope, there was a statistically significant difference between Conflicts detected by Endoscope and Conflicts detected by Microscope according to site of compression including cisternal portion and REZ, with p- value (p &amp;lt; 0.05). During comparison between preoperative and postoperative pain intensity score according BNI in Total patients during differenttime intervals for follow up (at 3 month, 6 month, 1 year), There was a highly statistically significant lowest pain score according BNI in postoperative compared to preoperative, with p-value (P &amp;lt; 0.001). Conclusion The advantages of microvascular decompression are still worthy. Cerebellar retraction in less than a pure microscopic intervention. Complications are minimal, view is exceptionally panoramic and focally in depth. Therefore, the endoscope can see what the microscope cannot see; therefore, avoidance of missing vascular compression and non- optimum outcome can be assured.

Trigeminal Microvascular Decompression for Medically Refractory Short-Lasting Unilateral Neuralgiform Headache Attacks: A Single-Center Retrospective Analysis.

Advancing Digital Surgery With Surgeon-Machine Interface: A Scalable Computer Vision Platform for Intraoperative Prediction and Analytics Demonstrated in Microvascular Decompression Surgery: Erratum.

Background: The coexistence of trigeminal neuralgia and hemifacial spasm is rare, usually caused by neurovascular compression. Although microvascular decompression is standard treatment, it can cause recurrence and complications. Korean medicine may be a complementary treatment option.Case: A 68-year-old woman developed right-sided trigeminal neuralgia with superior cerebellar artery contact at the trigeminal root and left-sided hemifacial spasm after right temporal lobe infarction. Despite pharmacotherapy, pain and spasms persisted.Interventions: During 22-day hospitalization, she received Igigeopoong-san-gami (combined with Oryeong-san), acupuncture, and placental pharmacopuncture. Although carbamazepine and gabapentin were maintained, duloxetine, tramadol, and naproxen were discontinued. This case followed the CARE guidelines.Outcomes: Pain improved (Numerical Rating Scale 5→1; BNI pain scale IV→II), and spasm resolved (Scott's description 3→0) without adverse events.Conclusion: Integrative Korean medicine may benefit patients with concurrent trigeminal neuralgia and hemifacial spasm after stroke. Large-scale, multicenter, prospective studies with long-term follow-up are warranted.