What is a Hemifacial Spasm?

Hemifacial spasm syndrome results from vascular compression and distortion of the 7th cranial or facial nerve resulting in painless twitching of the muscles of the face (figure 1,2), or facial muscle spasms.

Medical management is the first course of action for hemifacial spasm, together with chemodenvervation achieved by Botulinum Toxin injections. Microvascular decompression is reserved for patients with persistent hemifacial spasm symptoms despite these treatments. See videos below.

Figure 1
MR image demonstrating the posterior inferior cerebellar artery (red arrow) passing under and in close proximity of the facial nerve at its entry zone into the brainstem (white arrow).

Figure 2
Intraoperative image demonstrating artery (PICA) in apposition of the facial nerve (CN VII).

Demonstration of the surgical technique for the management of hemifacial spasm

Video illustrates the techniques necessary to surgically treat a 66 year old man with a 10 year history of hemifacial spasm.