# How I do it: combined interposition-transposition technique for microvascular decompression in primary hemifacial spasm

## TL;DR

This paper introduces a new surgical technique combining two existing methods to treat a facial movement disorder called hemifacial spasm.

## Contribution

A novel combined interposition-transposition technique using autologous muscle and Tachosil® for microvascular decompression in HFS.

## Key findings

- The combined technique is effective for curing HFS, especially when large arteries are involved.
- The method is presented with detailed surgical principles and a video for clarification.

## Abstract

Two surgical microvascular decompression techniques to treat primary hemifacial spasm (HFS) are described in literature. The “interposition” uses different materials as “spacers” while the “transposition” consists in suturing the offending vessel to the petrous bone dura mater. In the literature is described a transposition surgery adopting self-adhesive materials reporting promising results.

We describe a combination of these two techniques using autologous muscle and Tachosil®. The step-by-step surgical principles are described in the article and clarified in a video.

This procedure is effective to cure the HFS especially in case of large arteries when interposition only is insufficient.

The online version contains supplementary material available at 10.1007/s00701-025-06472-0.