Neurovascular Decompression for Hemifacial Spasm

-Transmastoid Approach-

Abstract

To avoid cochlear and vestibular nerve injury as much as possible, neurovascular decompression for hemifacial spasm via the mastoid was performed. This approach was superior to the classic suboccipital approach with respect to more direct accessibility to the 7th and 8th cranial nerves with less retracting the cerebullum and to minimum chance of subsequent trauma to the 8th cranial nerve. On the other hand, the disadvantages of this approach were less visualization of the cerebello-pontine angle and a more cautious maneuver to prevent CSF leakage. We recommend the transmastoid approach for the cases in which intratemporal tumors can not be ruled out as a cause of the hemifacial spasm.