How I do it: sling transposition technique with biopatch and aneurysm clip for hemifacial spasm

Background: Microvascular decompression (MVD) represents the only definitive and non-ablative treatment for hemifacial spasm (HS). Teflon is the most used interposing material because considered inert; nevertheless, it is not free from complications. Method: We discuss and illustrate our method to resolve the neurovascular conflict accounting for HS through a sling transposition technique using aneurysm clip and biopatch in carefully selected cases. Conclusion: Several MVD procedures, including interposing and transposing techniques, have been proposed for HS, mainly selected according to surgeon’s preference. We consider the described technique a definitive treatment, safe, not associated to pain recurrence and without needing revision surgery.