The Cornerstone Technique of Microvascular Decompression for Hemifacial Spasm with Vertebral Artery Offender

Abstract

Microvascular decompression surgery is the most effective treatment for hemifacial spasm (HFS). The vertebral artery (VA) is a larger and more elastic vessel, which makes surgical management moredifficult. We introduce a surgical technique of proximal Teflon transposition with interposition (PTTI) inthe vertebromedullary space for HFS with a VA offender. In 112 patients with HFS, 22 patients had a VA offender on the facial nerve exit zone. Six of 22 patients with a VA offender underwent surgery by traditional microvascular decompression at the facial nerve exit zone, and 16 patients underwent the PTTI technique. We compared surgical outcomes of the PTTI technique and the conventional technique for HFS associated withthe VA. We also compared surgical outcomes of the PTTI technique with outcomes of other alternative techniques. The PTTI technique was associated with a good operative prognosis and fewer complications. The PTTI technique is an easy, safe, and effective method for treatment of patients with HFS with a VA offender. The PTTI technique can be considered as another treatment option in addition to the transposition technique reported previously.