What to Expect After Microvascular Decompression Surgery for Hemifacial Spasm

If you've undergone microvascular decompression (MVD) surgery for hemifacial spasm, it's important to understand that symptom relief may not occur immediately. According to clinical studies and extensive patient data, approximately 30% of individuals experience what is known as "delayed resolution" of symptoms. This means that while some patients may notice improvement within the first few days—typically 1 to 3 days—symptoms such as facial twitching can return temporarily, mimicking pre-surgery conditions.

Why Twitching May Continue After Surgery

Even after successful surgical separation of the blood vessel from the facial nerve, residual neurological activity can persist. This is often due to prior damage to the myelin sheath surrounding the nerve—a condition called demyelination—which can lead to abnormal electrical signals. These erratic impulses may continue to trigger muscle contractions in the face, resulting in ongoing spasms despite a technically successful operation.

The Timeline for Recovery Varies

For many patients, full symptom relief occurs gradually. Clinical observations show that a significant number of individuals—again, around 30%—achieve complete remission between 3 to 6 months post-surgery. This delayed recovery period underscores the importance of patience and consistent follow-up with your neurosurgeon. The body needs time to heal at the neural level, and the nervous system often requires weeks or even months to stabilize after decompression.

When to Seek Follow-Up Care

Remaining in close contact with your surgical team is crucial. Regular check-ups allow doctors to monitor your progress, rule out complications, and assess whether additional interventions are needed. In most cases, once the compressing vessel is effectively repositioned or insulated, long-term relief is highly likely. However, temporary postoperative twitching should not be mistaken for surgical failure.

Managing Expectations After MVD Surgery

It's essential to maintain realistic expectations. While microvascular decompression offers one of the most effective long-term solutions for hemifacial spasm, healing is not always linear. Some degree of facial twitching during recovery is normal and does not indicate poor surgical outcome. With proper medical guidance, time, and monitoring, the majority of patients experience meaningful improvement and go on to achieve lasting symptom control.

In summary, continued facial muscle activity after MVD surgery is not uncommon and often resolves over time. Staying informed, attending scheduled appointments, and allowing your nervous system adequate time to recover are key steps toward a successful outcome.