Arterial Sling Decompression for Hemifacial Spasm.

Area of Science:

• Neurosurgery
• Neurology

Background:

• Hemifacial spasm (HFS) is a neurological disorder caused by compression of the facial nerve, often by vascular structures.
• Microvascular decompression (MVD) is a standard treatment, but complex cases involving large dolichoectatic vessels may require alternative surgical strategies.

Observation:

• A 36-year-old woman with severe, medically refractory left HFS presented with facial nerve compression by a dolichoectatic vertebrobasilar complex and AICA.
• Standard MVD was insufficient due to the large caliber of the offending vessel.

Findings:

• A novel "neck-tie" Dacron sling technique was employed to displace the vertebral artery from the facial nerve.
• The procedure, combined with MVD, successfully decompressed the facial nerve, evidenced by the absence of abnormal motor responses on neuromonitoring.
• The patient remained symptom-free at 6-month follow-up with an uneventful postoperative course.

Implications:

• The "neck-tie" sling technique offers a viable and effective solution for HFS cases involving large dolichoectatic vertebrobasilar systems.
• This approach expands the surgical armamentarium for complex cranial nerve compression syndromes.
• Careful patient selection and meticulous surgical technique are crucial for successful outcomes and complication avoidance.