Compression-specific treatment strategies for vertebroarterial-involved hemifacial spasm: A single-centre retrospective analysis of surgical techniques.

Hemifacial spasms (HFS) are often triggered by vascular compression of the facial nerve, with the vertebral artery (VA) playing a role in 10-20% of cases. This study retrospectively analyses surgical techniques for personalised treatment strategies in patients with VA-involved HFS to determine the most effective surgical approach based on VA characteristics. This retrospective study analysed 112 patients with VA-involved HFS who underwent microvascular decompression (MVD) from July 2020 to June 2023. Patients were categorised into four subtypes of VA-involved HFS based on VA characteristics and neurovascular contacts: Type I, where the compression point of the VA on the branch vessel is found outside the branch vessel's compression point on the facial nerve; Type II, with a vertically superimposed compression relationship, further divided into IIa (VA diameter < 4.5 mm) and IIb (VA diameter ≥ 4.5 mm); Type III, the tortuous pushing type with VA bending into an arc shape and compression and deforming facial nerve; and Type IV, the bilateral VA parallel type with both VAs on the same side of the lesion. Three surgical techniques were applied: interposition decompression with Teflon™ implants, suspension decompression with fibrin glue, and bridge-layered decompression. Postoperative outcomes showed no significant difference in symptom relief rates (p = 0.537) and early complications (p = 0.357) among the three groups. The study concludes that a tailored approach to decompression based on VA subtypes is practical for VA-involved HFS, emphasising the importance of selecting the appropriate surgical method based on specific VA characteristics.