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<p>Hemifacial spasm is commonly caused by a vascular compression of the facial nerve at its root exit zone (REZ), at brainstem. Microvascular decompression provides long-term cure in approximately 90% of the patients (delayed in one-third). Based on more than three hundred procedures, the authors advocate an inferior ventro-lateral brainstem approach. This trajectory optimizes access to the REZ, while minimizing traction on the cerebellum, the cochleo-vestibular nerve, and the labyrinthine artery. Decompression should be achieved by transposing the offending vessel (PICA, AICA, either alone or associated with a vertebro-basilar- dolichoectatic artery). Monitoring of brainstem auditory evoked potentials can be useful during learning curve.</p>

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How I do it: microvascular decompression for hemifacial spasm using an inferior ventrolateral brainstem approach

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月7日

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  • Gustavo Polo,
  • Joseph Maarrawi,
  • Marc Sindou

摘要

Hemifacial spasm is commonly caused by a vascular compression of the facial nerve at its root exit zone (REZ), at brainstem. Microvascular decompression provides long-term cure in approximately 90% of the patients (delayed in one-third). Based on more than three hundred procedures, the authors advocate an inferior ventro-lateral brainstem approach. This trajectory optimizes access to the REZ, while minimizing traction on the cerebellum, the cochleo-vestibular nerve, and the labyrinthine artery. Decompression should be achieved by transposing the offending vessel (PICA, AICA, either alone or associated with a vertebro-basilar- dolichoectatic artery). Monitoring of brainstem auditory evoked potentials can be useful during learning curve.