Bridge technique for hemifacial spasm with vertebral artery involvement: 2-Dimensional operative video

Microvascular decompression for hemifacial spasm (HFS) associated with the vertebral artery (VA) is more challenging than that for small arteries. Atherosclerotic VA and tortuous VA are associated with a low success rate and high incidences of complications. Artery relocation employing a Teflon sling is helpful for small arteries. However, a different decompression technique should be considered in VA-related HFS due to the stiffness of the offending artery. With our simple decompression technique providing a secure transposition that can be performed even in the narrow cistern, a rigid Teflon bar is inserted to hold up all offending vessels between the pontine surface and the cerebellar flocculus (the bridge technique). This simple technique easily creates a free space over the root entry zone (REZ), reduces surgical manipulation compared to conventional artery relocation with a Teflon sling, and provides more secure nerve decompression than inserting Teflon pledgets on the REZ. The critical factors for successfully performing the bridge technique are using a rigid Teflon bar that can hold the rebound force of the VA and a length appropriate to generate a free space over the REZ between the pons and the cerebellar flocculus. In this video, we demonstrate our bridge technique for VA-related HFS and discuss the advantages and disadvantages of this novel approach.