How I do it: combined interposition-transposition technique for microvascular decompression in primary hemifacial spasm

Abstract Background Two surgical microvascular decompression techniques to treat primary hemifacial spasm (HFS) are described in literature. The “interposition” uses different materials as “spacers” while the “transposition” consists in suturing the offending vessel to the petrous bone dura mater. In the literature is described a transposition surgery adopting self-adhesive materials reporting promising results. Method We describe a combination of these two techniques using autologous muscle and Tachosil ® . The step-by-step surgical principles are described in the article and clarified in a video. Conclusion This procedure is effective to cure the HFS especially in case of large arteries when interposition only is insufficient.