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Updated: Jun 26, 2026
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
How I do it: Implant-free transposition technique for microvascular decompression in hemifacial spasm
Melanie Kristt1,2, Raymond F Sekula3
1Department of Neurological Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, 710 W 168th St., 4th Floor, New York, NY, 10032, USA.
Background:
Hemifacial spasm (HFS) is most often caused by arterial compression of the facial nerve (CNVII). Microvascular decompression (MVD) of CNVII has excellent outcomes, achieving spasm freedom in approximately 90% of patients, and can be accomplished by inter positional or transpositional techniques.
Method:
We present a step-by-step description of an experienced surgeon's technique for MVD in HFS using vessel transposition with TachoSil®, supported by an illustrative video.
Conclusion:
In our experience, transposition using TachoSil® during MVD for HFS, in appropriately selected patients, is a safe and effective approach offering potential advantages over traditional materials and techniques.
