| Summary: | Ischemic complications are generally rare complications in microvascular decompression surgery for hemifacial spasm. We report a case of posterior inferior cerebellar artery (PICA) infarction post-microvascular decompression. A 68-year old woman with a 2-year history of right hemifacial spasm underwent microvascular decompression surgery. Preoperative magnetic resonance image (MRI) showed that her PICA ran through closely to the root exit zone of her facial nerve. We treated the PICA with a string of polytetra fluoroethylene. After surgery, the patient complained about vertigo, and her MRI revealed ischemic changes in the medulla. She was eventually discharged without any neurological deficit. We reviewed our intraoperative video and found that certain steps in the detachment of the vessel, and minor changes in vessel position could have induced vascular obstruction and ischemia. Herein, we also discuss the choice of decompression methods and emphasize that the transposition of vessels was too invasive in this case. An appropriate method of decompression should carefully be performed in such cases, and review of surgical videos is beneficial. Keywords: Ischemic complications, Microvascular decompression, Hemifacial spasm, Transposition
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