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Updated: Feb 18, 2026

Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
How I do it: endoscopic microvascular decompression for hemifacial spasm associated with the vertebral artery
Fuminari Komatsu1, Masaaki Imai2, Mitsunori Matsumae3
1Department of Neurosurgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan. fuminarikomatsu@gmail.com.
Background:
Microvascular decompression (MVD) of hemifacial spasm (HFS) associated with the vertebral artery (VA) shows higher rates of incomplete cure and complications compared to non-VA-related HFS.
Method:
Purely endoscopic MVD for VA-associated HFS via a retrosigmoid keyhole was performed. Neurovascular conflicts by a directly offending artery and VA around the root exit zone of the facial nerve were clearly demonstrated under 30° endoscopic view without significant cerebellar retraction. The VA and directly offending artery were safely transposed with preservation of perforators under excellent view.
Conclusion:
Endoscopic MVD offers reliable decompression for VA-associated HFS with minimal invasiveness.
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