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A Sling Swing Transposition Technique With Pedicled Dural Flap for Microvascular Decompression in Hemifacial Spasm

Khoo, Hui Ming MD*,‡; Yoshimine, Toshiki MD, PhD*; Taki, Takuyu MD, PhD

doi: 10.1227/NEU.0b013e318246aa74
Operative Technique

BACKGROUND: The key to successful microvascular decompression of the neurovascular compression syndrome is maintaining the separation between the nerve and the offending vessel.

OBJECTIVE: We describe a transposition technique in which a local pedicled dural flap, fashioned from the petrous posterior surface, is used to retract the offending vessel away from the root exit zone of the facial nerve in hemifacial spasm cases.

METHODS: We conducted a retrospective review of microvascular decompression operations in which the offending vessel was transposed and then retained by a local pedicled dural flap made from the dura of the petrous posterior surface.

RESULTS: This technique was used in 7 consecutive cases of the most recently operated series. Postoperatively, complete symptom relief was achieved in 100% of the patients without any significant surgical complications.

CONCLUSION: To our knowledge, this is the first report in which an autologous anatomic structure in the cerebellopontine angle, such as petrous dura mater, is used in the microvascular decompression of the facial nerve. This is a simple yet robust method and can be considered an option for the treatment of hemifacial spasm caused by arterial compression.

ABBREVIATIONS: AICA, anterior inferior cerebellar artery

HFS, hemifacial spasm

IAC, internal auditory canal

MVD, microvascular decompression

PICA, posterior inferior cerebellar artery

RExZ, root exit zone

VA, vertebral artery

*Department of Neurosurgery, Osaka University Medical School, Suita, Osaka, Japan

Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan

Correspondence: Taki Takuyu, MD, PhD, Department of Neurosurgery, Kansai Rosai Hospital, 3-1-69, Inaba-so, Amagasaki-shi 660-8511, Japan. E-mail:

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Received May 16, 2011

Accepted November 30, 2011

Copyright © by the Congress of Neurological Surgeons