Kawase Approach for "Macrovascular" Decompression of Dolichoectatic Basilar Artery Causing Hemifacial Spasm Using Gore-tex Sling: 2-Dimensional Operative Video.

Hemifacial spasm due to compression by dolichoectatic vertebrobasilar occurs in <1% of cases.1 Macrovascular decompression has been described for anteromedial transposition of the offending artery toward the clival dura2-4 and posteriorly to the petrous dura.5 We present the case of a 56-year-old woman who presented with a dolichoectatic basilar artery causing refractory left hemifacial spasm. She had previously undergone a retrosigmoid craniotomy for placement of Teflon felt around the dolichoectatic basilar artery; however, her spasm recurred 1.5 years later. Imaging revealed a dolichoectatic basilar compressing the exit zone of the left facial nerve. To the best of our knowledge, we report the first case of successful transposition of a dolichoectatic basilar in an anterolateral/superior direction with a sling secured in Glasscock's triangle through the Kawase approach. Postoperatively, the patient had immediate improvement and remained symptom-free at 3.5 years of follow-up. The case presentation, surgical anatomy, operative technique, and postoperative course and outcomes are reviewed. The alternative directions of pull are reviewed with medical artist's rendered illustrations. The patient gave consent for participating in the publication of this surgical video and consented to the publication of her image.