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

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 ® , supported by an illustrative video. In our experience, transposition using TachoSil ® during MVD for HFS, in appropriately selected patients, is a safe and effective approach offering potential advantages over traditional materials and techniques.