We present a very rare case of hemifacial spasm in a 58-year-old patient who was predisposed by focal temporal bone hyperostosis. The patient presented with a 6-year history of progressive left hemifacial spasm, unresponding to the conservative treatment. She underwent a typical microvasular decompression procedure, during which an unusual local hyperostosis of the interior surface of the left temporal bone was found, distorting the adjacent AICA and causing significant pressure on the facial nerve. The postoperative course was uneventful and in the 24-month follow up, the patient is spasm free.
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