How I do it: Implant-free transposition technique for microvascular decompression in hemifacial spasm.

Kristt, Melanie; Sekula, Raymond F · Acta Neurochir (Wien) · 2026

other · Level V

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Abstract

Hemifacial spasm (HFS) is most often caused by arterial compression of the facial nerve (CNVII). Microvascular decompression (MVD) of CNVII has excellent outcomes, achieving spasm freedom in approximately 90% of patients, and can be accomplished by inter positional or transpositional techniques. We present a step-by-step description of an experienced surgeon's technique for MVD in HFS using vessel transposition with TachoSil<sup>®</sup>, supported by an illustrative video. In our experience, transposition using TachoSil<sup>®</sup> during MVD for HFS, in appropriately selected patients, is a safe and effective approach offering potential advantages over traditional materials and techniques.