To discuss the fully endoscopy vascular decompression by the suboccipital key hole approach for treatment of hemifacial spasm (HFS).

The clinical data of 35 patients with HFS who were treated from May 2019 to July 2020 in Neurosurgery Department of Ningbo Yinzhou Second Hospital were analyzed retrospectively. All patients were treated with the vascular responsibility of decompression facial nerve root (i.e.the root emerging zone, the root exit zone and the transitional zone) under endoscope. All patients were followed up for 5-19 months and the therapeutic effect were evaluate.

The offending vessels were divided into two groups: (1) single vessel compression, including anterior inferior cerebellar artery (AICA) 21(60%), posterior inferior cerebellar artery (PICA) 2(5.7%); (2) complex vascular compression, AICA+PICA 4(11.4%), PICA+VA 4(11.4%), AICA+VA 3(8.6%), AICA+PICA+VA 1(2.9%). No venous compression were observed in all patients. Thirty-three patients have excellent effect and 2 patients have a good effect.

Through the suboccipital key hole approach, the facial nerve root and responsible vessels can be clearly observed under endoscope, and decompression operation can be carried out. The postoperative effect is good.