Acupuncture alleviates peripheral facial paralysis caused by structural anomalies of the anterior inferior cerebellar artery inducing neural edema: A case report

• AICA compression triggers inflammatory cascade, causing refractory edema. • Recurrent edema from structural factors may lead to steroid-resistant facial palsy. • Cranial MRI identifies neurovascular structural anomalies responsible for PFP. • Acupuncture reduces edema, uniquely effective in steroid-resistant PFP. Peripheral facial paralysis (PFP) caused by neurovascular structural anomalies frequently triggers an inflammatory cascade, leading to facial nerve edema. Standard treatments like corticosteroids usually don't work very well, while acupuncture shows special benefits in treating PFP. This report discusses a case where acupuncture was used to treat hormone-insensitive PFP caused by swelling of the facial nerve due to an unusual physical structure of the right anterior inferior cerebellar artery (AICA). The goal is to improve clinicians' diagnosis and treatment accuracy for this possible cause and to highlight acupuncture's therapeutic effect. We used the cranial magnetic resonance imaging (MRI) to clarify the etiology of hormone-insensitive PFP and formulated an acupuncture treatment plan. The acupuncture treatment restored the facial nerve's function after seven sessions. We performed a cranial MRI again to observe the facial nerve edema and its relationship with the surrounding vascular structures. Before acupuncture treatment, the patient's head MRI showed that the right AICA and the right facial nerve had a “U-shaped” abnormal physiological structure, and the local edema of the facial nerve was obvious. The left AICA had a cross interaction with the facial nerve and the auditory nerve in the inner ear canal. After 7 times of acupuncture treatment, the facial nerve function of the patient recovered, and reexamination of the head MRI showed that the local edema significantly subsided. PFP which is caused by facial nerve edema resulting from abnormal neurovascular physiological structures is insensitive to hormonal therapy. Acupuncture can be used to promote the resolution of the edema and the restoration of facial nerve function.