How I do it: minimizing muscle damage in microvascular decompression for hemifacial spasm.

Background: Key hole surgery was recruited for MVD surgery since the maneuver is through the small space between the cerebellum and temporal/occipital bone. However, even small wounds can cause severe postoperative pain if there is significant tissue damage. Attention has been given to the size of the craniotomy rather than to the skin incision or soft tissues such as muscles. Method: Suboccipital muscle dissection focusing on splitting the splenius capitis muscle was presented. The dura was reapproximated without additional dissection to harvest a fascia graft. Conclusion: Muscle injury should be minimized to alleviate postoperative pain. [ABSTRACT FROM AUTHOR]