title: An easy adjustable method of ectatic vertebrobasilar artery transposition for microvascular decompression.
abstract: BACKGROUND
  Microvascular decompression (MVD) of trigeminal neuralgia (TN) or hemifacial spasm (HFS) caused by an elongated, tortuous or enlarged vertebral or basilar artery has a higher rate of incomplete cure.
  
  
  OBJECTIVE
  We used an easily applied and adjustable method of vertebrobasilar artery transposition and fixation to improve the immediate surgical outcome of MVD of TN or HFS due to compression by an ectatic vertebrobasilar artery system.
  
  
  METHODS
  Vertebral or basilar artery transposition was performed using the vascular sling with a strip of unabsorbable dural tape. The vertebrobasilar artery-sling complex was then fixed to the dura over the petrous bone by aneurysm clip through the dural bridge. The direction and angle of traction on the vertebrobasilar artery was adjustable using different lengths of clip or the horizontal level of the dural bridge.
  
  
  RESULTS
  The sling and clip fixation method has been applied in 7 cases of MVD associated with vertebral or basilar artery compression. All 3 patients with TN and one with HFS had total remission of symptoms right after the procedure; one patient was completely free of spasm within 1 week after MVD and one had achieved 80% improvement of spasm in his last clinical visit 3 months after MVD. There was no major surgical complication in these 7 patients. Surprisingly, refractory hypertension was unexpectedly cured in one patient with TN following the procedure.
  
  
  CONCLUSIONS
  The vertebrobasilar artery transposition and fixation method used in the present study provided surgeons an easy and adjustable way to perform MVD safely and effectively.
authors.affiliation: Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan.
authors.forename: Chun-Fu
authors.initials: CF
authors.lastname: Lin
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Chen
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
authors.forename: Cheng-Chia
authors.initials: CC
authors.lastname: Lee
authors.forename: Chih-Hsiang
authors.initials: CH
authors.lastname: Liao
authors.forename: Shao-Ching
authors.initials: SC
authors.lastname: Chen
authors.forename: Min-Hsiung
authors.initials: MH
authors.lastname: Chen
authors.forename: Yang-Hsin
authors.initials: YH
authors.lastname: Shih
authors.forename: Sanford P C
authors.initials: SP
authors.lastname: Hsu
mesh_terms: D000368:Aged; D005154:Facial Nerve / Q000601:surgery; D005157:Facial Pain / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D019569:Hemifacial Spasm / Q000209:etiology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D010579:Petrous Bone / Q000601:surgery; D013525:Surgical Instruments; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000601:surgery; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000473:pathology / Q000601:surgery*