Microvascular Decompression: The Leading Surgical Solution for Hemifacial Spasm

Understanding the Causes Behind Facial Twitching

Facial spasms, medically known as hemifacial spasm, can significantly impact a person's quality of life. These involuntary muscle contractions on one side of the face stem from various underlying causes, and treatment approaches differ accordingly. In rare cases, facial twitching is caused by a brain tumor pressing on the facial nerve. In such instances, surgical removal of the tumor is necessary to relieve the pressure and resolve symptoms.

The Most Common Cause: Vascular Compression

However, the vast majority of hemifacial spasm cases are due to neurovascular compression—specifically, when a nearby blood vessel compresses the facial nerve at its root entry zone into the brainstem. This chronic irritation leads to abnormal signaling, resulting in persistent muscle twitching. For these patients, microvascular decompression (MVD) has emerged as the most effective long-term solution.

How Microvascular Decompression Works

MVD is a highly precise neurosurgical procedure designed to alleviate pressure on the affected cranial nerve. The surgery involves making a small incision—typically about 1 centimeter—behind the ear on the affected side. A small opening, approximately 2 centimeters in diameter, is then carefully created in the skull to access the brainstem area.

Using advanced microscopic visualization, the neurosurgeon delicately separates the offending blood vessel from the facial nerve. A tiny cushioning material, often made of biocompatible Teflon felt, is placed between the vessel and nerve to prevent future contact. This effectively stops the abnormal nerve signaling responsible for the spasms.

Minimally Invasive with Rapid Recovery

Thanks to advances in neurosurgical techniques and imaging technology, MVD is now considered minimally invasive. Many patients are able to get out of bed and walk the day after surgery, with hospital stays typically lasting just 2–3 days. Most individuals notice a significant reduction or complete resolution of their facial twitching within weeks of the procedure.

Safety, Risks, and Success Rates

No surgical procedure is entirely without risk, and microvascular decompression is no exception. Potential complications may include temporary hearing changes, facial weakness, or cerebrospinal fluid leakage, but these occur in a small minority of cases. Serious adverse events are rare, especially when the surgery is performed by an experienced neurosurgical team.

Despite these risks, MVD boasts high success rates—over 85% of patients experience long-lasting relief from their symptoms. For individuals suffering from chronic hemifacial spasm that impacts daily function and confidence, this procedure offers a proven and transformative solution.