Microvascular triple decompression for combined simultaneous trigeminal neuralgia, hemifacial spasm, and pulsatile tinnitus due to separate offending vessels

Neurovascular compression syndrome is generally caused by vascular at the root entry or exit zone of corresponding cranial nerve. Trigeminal neuralgia most frequent syndrome, followed hemifacial spasm. Despite ongoing debate in literature, pulsatile tinnitus also known to be a neurovascular resulting from vestibulocochlear Combined manifestations symptoms are very rare. We report case with simultaneous manifestation trigeminal neuralgia, spasm, and as separate offending vessels. A 53-year-old female presented lancinating pain left face, ipsilateral for 2 years. spasm were diagnosed after neurological examination, imaging study, electromyography. Microvascular decompression via retrosigmoid approach offenders, including superior cerebellar artery, anterior inferior posterior artery was performed using Teflon sponges. The patient’s tinnitus, improved immediately microvascular decompression.