Acta Neurochirurgica

, Volume 157, Issue 5, pp 803–806 | Cite as

Lateral basal approach with a supine, no-retractor method for microvascular decompression for hemifacial spasm

  • Katsuyoshi ShimizuEmail author
  • Masaki Matsumoto
  • Akira Wada
  • Tohoru Mizutani
How I Do it - Neurosurgical Techniques



We describe the details of our unique surgical procedures for microvascular decompression for hemifacial spasm.


A patient is just laid supine, skipping the complicated preparation for the lateral or park-bench position. The subfloccular approach from a small cranial window situated on the more lateral and basal side of the occipital cranium enables the surgeon to reach all the segments of the facial nerve root without cerebellar retraction by a spatula.


We believe this approach is ideal for the safe and precise decompression of any part of the facial nerve root.


Hemifacial spasm Microvascular decompression Supine position No retractor 


Conflict of interest


Supplementary material


The movie demonstrating the typical superficial manipulations and intradural procedures on the right side. Transpositon of the PICA-AICA complex at the RExZ. (MP4 78539 kb)


  1. 1.
    Zhang M, Lee AS (2002) The investing layer of the deep cervical fascia does not exist between the sternocleidomastoid and trapezius muscles. Otolaryngol Head Neck Surg 127:452–454CrossRefPubMedGoogle Scholar
  2. 2.
    Campos-Benitez M, Kaufmann AM (2008) Neurovascular compression findings in hemifacial spasm. J Neurosurg 109:416–420CrossRefPubMedGoogle Scholar
  3. 3.
    De Ridder D, Moller A, Verlooy J, Cornelissen M, De Ridder L (2002) Is the root entry/exit zone important in microvascular compression syndromes? Neurosurgery 51:427–433PubMedGoogle Scholar
  4. 4.
    Gardner WJ, Sava GA (1962) Hemifacial spasm—a reversible pathophysiologic state. J Neurosurg 19:240–247CrossRefGoogle Scholar
  5. 5.
    Jannetta PJ, Abbasy M, Maroon JC, Ramos FM, Albin MS (1977) Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg 47:321–328CrossRefPubMedGoogle Scholar
  6. 6.
    McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK (1999) Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90:1–8CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • Katsuyoshi Shimizu
    • 1
    Email author
  • Masaki Matsumoto
    • 1
  • Akira Wada
    • 1
  • Tohoru Mizutani
    • 1
  1. 1.Department of NeurosurgeryShowa University School of MedicineShinagawa-kuJapan

Personalised recommendations