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

Microvascular Decompression for Hemifacial Spasm Associated with Vertebrobasilar Artery

“…of the larger vessels, vertebral or basilar arteries 14) because the comprehension of the anatomical relationships of the vessels and defining the precise structure compressed could be troublesome 20) . In this study, anatomical relationships of the related structures in operative field, treatment outcomes and clinical courses were analyzed retrospectively in patients who underwent MVD for HFS caused by large blood vessels such as the lengthened vertebral artery or the basilar artery.…”

“…Therefore, many authors suggested various modified methods other than conventional MVD 4,14,15,19,26,27) . Nevertheless, the outcome of facial spasm caused by the larger arteries is not satisfactory.…”

Microvascular decompression for hemifacial spasm due to four offending vessels: a case report

“…The first type is less desirable because the procedure is performed to the nerve rather than to the offending arteries. The second type is considered reasonably good; however, it requires a wider space (11). In our case, we performed wide and enough arachnoid dissection for increasing movability of the offending vessels, and then the vessels became easily movable state.…”

“…Because The tortuous vertebrobasilar artery is often firm and difficult to move, 1) the insertion of a prosthesis between the artery and the nerve is not easily achieved, 2) the REZ of the facial nerve root receives relatively higher pressure, and 3) despite the same extent of microvascular decompression, the possibility that the pulsatile signal may still be remaining is high. Therefore, many authors suggested various modified methods other than conventional microvascular decompression (3,10,11,13,14,(17)(18)(19)(21)(22)(23)(24). The first method is to dislocate or cover the nerve because of the difficulties of dislocating the greater vessels (23,24).…”

Complication Caused by Use of Fibrin Glue in Vessel Transposition for Trigeminal Neuralgia -Case Report-

“…The main cause of recurrence is adhesion between the implant and the adjacent neurovascular structures. 1,2,7,9) Transposition techniques have recently been used instead of interposition techniques to avoid such adhesion. The sling retraction technique is particularly recommended.…”