Surgical Techniques of Microvascular Decompression for Hemifacial Spasm

Abstract

Microvascular decompression (MVD) has been accepted as the most effective treatment for hemifacial spasm (HFS). Many surgeons from different countries and areas have concentrated on this procedure, aiming to increase the cure rate and lower the risks. In this chapter we introduced our viewpoints on MVD surgery, based on our experience from about 1200 MVD surgeries each year. We discussed the whole course of management, from diagnosis to patient selection, from anesthesia to surgical procedure, and from preoperative evaluation to postoperative management. We put our emphasis on the techniques of MVD, in which part we discussed the approaches, exploration range, and decompression method. We described some challenging situations, such as large sclerosed vertebral artery, degeneration of facial nerve, offending vessels between facial nerve and acoustic nerve, as well as offending vessels going through the fibers of facial nerve. We also discussed some special cases, including persistent AMR waves, no vascular compression found, and dual side HFS. We developed a new criterion for ending an MVD surgery. We hope our experiences would be helpful for surgeons who are specialized in cranial nerve surgeries.