Microvascular decompression for hemifacial spasm caused by the vertebral artery: a simple and effective transposition method using surgical glue

Abstract

Background Microvascular decompression for the treatment of trigeminal neuralgia and hemifacial spasm (HFS) has been established and has brought about excellent results. However, recurrence or lack of relief from the symptoms was experienced in some cases in which the nerve root or root exit zone were compressed by the vertebral (VA) and basilar arteries. We experienced a severe HFS case, mainly caused by a compression with the tortuous VA. A more simple transposition technique of the offending VA using surgical glue is reported. Methods A 64-year-old male had been suffering from HFS for six years. The tortuous right VA with anterior inferior cerebellar arteries (AICA) was considered to be responsible for his vascular compression syndrome. The VA was carefully and slowly dislocated away from the pontomedullary junction toward the cranial base. Then the arteriosclerotic portion of the VA wall was chosen, where a small piece of Surgicel (ETHICON, Inc., Somerville, NJ) is placed beforehand so as to use a minimum amount of glue (Biobond; Mitsubishi Pharma Corp., Osaka, Japan). Until the glue is hardened, the VA is held away from the brain stem. After this procedure, the ordinary transposition of AICA branches was added. Results The annoying HFS completely disappeared immediately after the operation. Conclusion The advantage of our method is the simplicity of the procedure. It requires less space and time while the other methods using tapes, strips, and clips need a greater working space and more time.