How I do it: microvascular decompression for hemifacial spasm using an inferior ventrolateral brainstem approach.

Area of Science:

• Neurosurgery
• Neurology

Background:

• Hemifacial spasm (HFS) often results from vascular compression of the facial nerve at the brainstem's root exit zone (REZ).
• Microvascular decompression (MVD) is an effective treatment, achieving long-term cure in about 90% of patients.

Purpose of the Study:

• To advocate for an inferior ventro-lateral brainstem approach for MVD in treating HFS.
• To detail the surgical trajectory and decompression techniques for optimal outcomes.

Main Methods:

• Retrospective analysis of over 300 MVD procedures for HFS.
• Utilizing an inferior ventro-lateral brainstem surgical trajectory.
• Vessel transposition to decompress the facial nerve from offending arteries (PICA, AICA, vertebro-basilar dolichoectatic artery).

Main Results:

• The inferior ventro-lateral approach provides optimal access to the REZ.
• This trajectory minimizes traction on critical neurovascular structures like the cerebellum and cochleo-vestibular nerve.
• Successful decompression is achieved through vessel transposition.

Conclusions:

• The inferior ventro-lateral brainstem approach is a safe and effective surgical strategy for MVD in HFS.
• This technique optimizes surgical access and minimizes risks to adjacent neural and vascular structures.
• Monitoring brainstem auditory evoked potentials can aid surgeons during the learning curve.