Macrovascular Decompression for Hemifacial Spasm Using Sling Technique.

Hemifacial spasm (HFS) is a painless, involuntary twitching of the facial muscles that usually involves the orbicularis oculi muscle.1,2 It is commonly caused by the anterior inferior cerebellar artery or posterior inferior cerebellar artery.1,2 However, a dolichoectatic vertebrobasilar artery (VBA) can impinge the facial nerve.1 Macrovascular decompression with sling transposition is a common management paradigm.1-9 We present a case of a 56-year-old male who presented with left-sided HFS, pulsatile tinnitus, and hearing loss for the past 2 years. The patient underwent a retrosigmoid craniotomy and Gore-Tex sling transposition of a dolichoectatic VBA (Video 1). Complete improvement of symptoms was noted postoperatively with no associated complications. We review the preoperative workup, operative technique, relevant anatomy, and literature and provide technical pearls for this procedure.