Microvascular decompression for hemifacial spasm: a review of twenty-one operated cases

Abstract Background Microvascular decompression of facial nerve provides definitive and long-term cure for hemifacial spasm. We review our experience of treating hemifacial spasm by microvascular decompression. Objectives To evaluate the results of microvascular decompression of facial nerve for hemifacial spasm and to discuss the critical steps during surgery necessary to achieve a good result. Patients and methods Twenty-one cases of hemifacial spasm operated by the author were analysed. All the patients underwent microvascular decompression of the facial nerve by the retromastoid approach. Preoperative and postoperative videos of the patients were made with their consent. Patient outcome and complications were analysed. Results Twenty patients had complete resolution of the spasm after surgery. The second operated patient had facial palsy with hearing loss in the immediate postoperative period and recurrence of the spasm after 6 months of surgery. Postoperative mild transient facial weakness in one patient, mild sensory-neural hearing loss in two, delayed facial palsy which resolved completely in two patients, transient facial twitching which responded to carbamazepine in one and paradoxical CSF rhinorrhea treated successfully by lumbar drainage in one patient were the complications noted. Conclusion Hemifacial spasm is best treated by surgery, and our results compare favourably with those in the existing literature. Sensorineural hearing loss and facial nerve palsy are the main complications to be expected during the learning curve.