Abstract
Hemifacial spasm is a neuromuscular disorder caused by compression of the facial nerve
at the nerve root entry zone, often due to ectatic or aberrant vasculature. Pathologic
compression of the nerve–brainstem interface results in involuntary, paroxysmal contractions
of ipsilateral facial muscles that may cause considerable impairments in quality of
life. For those with severe symptoms, have positive imaging demonstrating vascular
compression, or who fail other management modalities,[1]
[2]
[3]
[4] microvascular decompression offers potential definitive treatment.[5]
[6] Traditionally, nonabsorbable packing agent is used to pack between the nerve and
offending vascular structure. However, for large and more complex arterial structures,
simple nonabsorbable padding is often not sufficient.
In this operative video, we demonstrate microvascular decompression for intractable
hemifacial spasm in a 52-year-old female using a specialized sling tacked to the petrous
dura for management of a large, ectatic vertebral artery. Following a standard left
retrosigmoid craniotomy, an atheromatous ectatic vertebral artery was identified.
We fashioned a bovine pericardium sling around the vessel and used a permanent aneurysm
clip to secure it to an incision portion of petrous dura. We subsequently identified
potential additional facial nerve root compression by anterior inferior cerebellar
artery (AICA) and posterior inferior cerebellar artery (PICA) branches, which were
elevated and secured using Teflon felt packing. Following elevation of all three vessels,
the lateral spread response resolved. At 2 weeks postoperatively, the patient reported
substantial relief in her hemifacial spasms and endorsed highly improved quality of
life.
Keywords
hemifacial spasm - vertebral artery - sling
