Hemifacial Spasm MVD
Microvascular decompression (MVD) for hemifacial spasm is a highly effective neurosurgical procedure that permanently relieves involuntary facial twitching by removing the pressure of a blood vessel on the facial nerve at the brainstem. The surgical technique is very similar to MVD for trigeminal neuralgia, performed through a small incision behind the ear.
When this procedure may be recommended
- Hemifacial spasm causing disabling involuntary facial twitching not adequately controlled by Botox injections.
- Patient preference for a definitive surgical cure rather than ongoing Botox treatments.
- MRI-confirmed neurovascular compression of the facial nerve at the brainstem.
Who may be a candidate
Ideal candidates are patients with classical hemifacial spasm with MRI evidence of vascular compression, who are medically fit for general anaesthesia and a posterior fossa approach. The procedure is not recommended for patients whose facial twitching has other causes (e.g., benign essential blepharospasm).
Advanced medical implant technology (no text). Alternatives to surgery
- Botulinum toxin (Botox) injections every 3 to 6 months — effective but requires lifelong repeat treatments.
- Anticonvulsant medications (carbamazepine, gabapentin) — limited efficacy for hemifacial spasm.
- Observation if symptoms are mild and tolerable.
What to expect
- Anaesthesia and Positioning: General anaesthesia is administered. The patient is positioned on their side with the affected ear facing upward.
- Retromastoid Incision: A small incision (approximately 6 cm) is made behind the ear.
- Keyhole Craniotomy: A small bone window is created to expose the posterior fossa dura.
- Brainstem Approach: The dura is opened, and the cerebellum is gently retracted to expose the facial nerve at its exit from the brainstem.
- Vessel Identification: The offending artery (usually AICA or PICA) compressing the facial nerve is identified under the operating microscope.
- Decompression: A small Teflon felt pad is placed between the blood vessel and the facial nerve, permanently relieving the compression.
- Closure: The dura, bone, and scalp are meticulously closed.
Technology and imaging
Performed under high-magnification operating microscopy with continuous intraoperative facial nerve EMG monitoring and brainstem auditory evoked response (BAER) monitoring to protect hearing.
High-precision diagnostic imaging visualization. 
Clinical Zeiss/Leica operating microscope setup. Hospital stay
Typically 2 to 4 nights in hospital.
Recovery milestones
- Day 1: Ward mobilisation. Facial spasms may resolve immediately or improve gradually over weeks.
- Weeks 1-4: Home rest. Expect mild neck stiffness, temporary dizziness, and wound healing. Sutures removed at 10-14 days.
- Weeks 4-12: Gradual resolution of residual facial twitching. Some patients experience delayed resolution over several weeks as the nerve recovers.
- Week 6+: Clinical review to assess outcome.
Post-operative mobilization and recovery milestones. Risks and complications
- Hearing loss on the operated side (1% to 3% risk due to proximity of the auditory nerve).
- Facial weakness (usually transient, due to surgical manipulation of the facial nerve — 2% to 5%).
- Cerebrospinal fluid leak (1% to 2%).
- Incomplete relief or recurrence of spasms (5% to 10%).
- Standard posterior fossa craniotomy risks: infection, bleeding, meningitis.
Frequently asked questions
How quickly does the facial twitching stop after MVD?
In many patients, the hemifacial spasm resolves immediately after surgery. However, in approximately 30% to 40% of patients, the spasms gradually diminish over weeks to months as the facial nerve recovers from years of chronic irritation. This delayed resolution does not mean the surgery was unsuccessful.
Is MVD for hemifacial spasm the same as MVD for trigeminal neuralgia?
The surgical approach is very similar — both involve a small incision behind the ear and placement of a protective pad between a blood vessel and a cranial nerve. The key difference is which nerve is being decompressed: the facial nerve (CN VII) for hemifacial spasm, or the trigeminal nerve (CN V) for trigeminal neuralgia.