Recently, a male patient in his 40s from Linyi area with a 4-year history of right-sided facial muscle spasm (grade 4) was admitted. The patient’s face throbbed frequently, almost without stopping, and it caused the neck muscles to twitch as well, which was very painful. Preoperative nerve MRI revealed that the facial nerve was compressed by the vertebrobasilar artery and the anterior inferior cerebellar artery, a very rare and complicated case. Intraoperatively, it was found that the vertebrobasilar artery and anterior inferior cerebellar artery occupied the cerebral pool space and caused difficulties in releasing cerebrospinal fluid, making it difficult to reveal the facial nerve. The posterior group of cranial nerves was compressed by the basilar artery and pushed upward in an arch shape, but there was no lingual-pharyngeal neuralgia, no choking on water, and no hoarseness of voice. The surgery was finally completed successfully. After the operation, the patient’s facial twitching completely disappeared, and there was no facial palsy, no hearing loss or tinnitus, no pharyngeal pain, no drinking and choking cough and hoarseness, and the patient was very happy that the pain of many years was finally solved. In conclusion: this is a rare and very complicated case, the key is still to decompress the repetition and the vessels reach nudge away from the facial nerve. This will solve the problem.