AICA compression causing dual cranial neuropathy: A case of trigeminal neuralgia and facial nerve palsy

• Rare case of concurrent trigeminal neuralgia and facial nerve palsy. • AICA vascular loop compressing both trigeminal and facial nerves. • Single-stage microvascular decompression resolved dual neuropathy. • Chronic compression may cause irritative and destructive syndromes. Classical trigeminal neuralgia (TN) is most often caused by neurovascular compression of the trigeminal root. The coexistence of TN and facial nerve palsy due to compression by the same vessel is exceptionally rare. A 61-year-old man presented with medically refractory right-sided TN accompanied by mild ipsilateral facial weakness. MRI demonstrated neurovascular conflict involving both the trigeminal and facial nerves by the anterior inferior cerebellar artery (AICA). The patient underwent single-stage microvascular decompression (MVD) with favorable outcome. Neurovascular compression syndromes typically affect a single cranial nerve in isolation. Unlike previously reported dual neurovascular syndromes that typically involve hemifacial spasm, this case represents a destructive facial neuropathy secondary to chronic vascular compression. Awareness of this condition underscores the link between chronic vascular compression and neural damage, with meticulous decompression offering sustained clinical benefit. We report a rare case of concurrent TN and facial palsy caused by AICA compression, successfully managed with MVD. This highlights the need to consider atypical neurovascular conflicts in patients with combined cranial neuropathies.