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Updated: Mar 17, 2026
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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
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Simple Microvascular Decompression for Hemifacial Spasm Caused by Dolichoectatic Vertebral Artery.
Adel Azghadi1, Marte van Keulen, Sepideh Amin-Hanjani
1Department of Neurological Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland , Ohio , USA.
Operative Neurosurgery (Hagerstown, Md.)
|June 3, 2025
Summary
Simple microvascular decompression effectively treats hemifacial spasm (HFS) caused by dolichoectatic vertebral arteries (VA). Relocating the compression point away from the nerve
Area of Science:
- Neurosurgery
- Vascular Neurology
Background:
- Hemifacial spasm (HFS) secondary to dolichoectatic vertebral artery (VA) is rare and challenging.
- Standard treatments like Teflon slings or VA reanastomosis have limitations.
Purpose of the Study:
- To evaluate the efficacy of simple microvascular decompression for HFS caused by dolichoectatic VA.
- To demonstrate an alternative to complex surgical interventions.
Main Methods:
- Retrosigmoid craniotomy performed on a 67-year-old patient with left-sided HFS.
- Mobilization of the dolichoectatic VA and padding of the compression point at the root entry zone (REZ) with Teflon pledgets.
Main Results:
- Complete resolution of debilitating HFS symptoms achieved.
- Successful decompression of the REZ, despite residual compression in the cisternal segment.
Conclusions:
- Decompression of the REZ alone is a simple and effective treatment for HFS caused by dolichoectatic VA.
- This approach avoids more complex and higher-risk surgical options.
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