Introduction: Hemifacial spasm characterized by involuntary paroxistic contractions of the face is more frequent on left side and in females. Evolution is progressive and in a few cases may disappear. Management includes medical treatment, botulinum toxin and microvascular decompression of the nerve.

Methods: We present the results of 224 microvascular decompressions performed by one surgeon in 194 patients over 20 years from may 1992 to may 2011.

Results: Most of the patients had previous medical treatment. All patients were operated on with microsurgical technique by asterional craniotomy. Vascular compression was present in most of the cases. Follow-up was from 1 to 120 months. Gender: 63% female, 37% male. Age average 50.2 years. Starting age: 44.6 years. Time before surgery: 6.6 years. Side: 58.5% left, 41.5% right. Start: Typical 90.7%. Offending Vessel: None: 9, SUCA: 8, AICA: 148, PICA: 12, Basilar: 10, 2 vessels: 8. Excellent results after first surgery 82%, good results in 17.5% and 1 death. 27 patients requiered a second surgery with excellent results in 88.8%, 3 patients requiered a thrid exploration with cessation of the spams in all of them. Hipoacusia and transitory facial palsy were the most common complications in 9% of the patients. Long term results were excellent in 84.2% with cessation of the spasm, improvement in 15.3% and 1 death.

Conclusions: Hemifacial spasm is a painless but disabling entity. Medical treatment is effective in a limited fashion. Injection of botulinum toxin has good response but benefit is transitory. Microvascular decompression is treatment of choice because it is minimally invasive, not destructive, requires minimum technical support, and yields best long-term results with less complications.

Patient Care: There are many treatments for hemifacial spasm, but some of them just provide transitory benefits, and the surgery is a save option with long term results and less complications.

Learning Objectives: By the conclusion of this session, participants should known that microvascular decompression is a save and efficient treatment for hemifacial spasm, with great results and less morbility.

References: 1. Auger RG. Hemifacial spasm: clinical and electrophysiologic observations. Neurology 1979;29:1261-1272. 2. Digre K, Corbett JJ. Hemifacial spasm: differential diagnosis, mechanism, and treatment. Adv Neurol 1988;49:151-176. 3. Ehni G, Woltman HW. Hemifacial spasm: review of one hundred and six cases. Arch Neurol Psychiatry 1945;53:205-211. 4. Kraft SP, Lang AE. Cranial dystonia, blepharospasm and hemifacial spasm: clinical features and treatment, including the use of botulinum toxin. Can Med Assoc J 1988;39:837-844. 5. Jannetta PJ. Cranial rhizopathies. In: Youmans JR, editor. Neurological surgery. 3rd ed. Philadelphia, PA, USA: WB Saunders;1990.pp. 4169-4182. 6. Montagna P, Imbriaco A, Zucconi M, Liguori R, Cirignotta F, Lugaresi E. Hemifacial spasm in sleep. Neurology 1986;36:270-273. 7. Jho HD, Jannetta PJ. Hemifacial spasm in young people treated with microvascular decompression of the facial nerve. Neurosurgery 1987;20:767-770. 8. Langston JW, Tharp BR. Infantile hemifacial spasm. Arch Neurol 1976;33:302-303. 9. Carter JB, Patrinely JR, Jankovic J, McCrary JA III, Boniuk M. Familial hemifacial spasm. Arch Ophthalmol 1990;108:249-250. 10. Friedman A, Jamrozik Z, Bojakowski J. Familial hemifacial spasm. Mov Disorders 1989;4:213-218. 11. Lundberg PO, Westerberg CE. A hereditary neurological disease with facial spasm. J Neurol Sci 1968;8:85-100. 12. Cushing H. The major trigeminal neuralgias and their surgical treatment based on experience with 332 gasserian operations. Am J Med Sci 1920;160:157-184. 13. Cook BR, Jannetta PJ. Tic convulsif: results in 11 cases treated with microvascular decompression of the fifth and seventh cranial nerves. J Neurosurg 1984;61:949-951. 14. Revuelta GR, Becerril PPR, Beltrán RJA, Vales HLO. Tic convulsivo doloroso: tratamiento por microcraniectomía. An ORL Mex 1996;41:218-220. 15. Magun R, Esslen E. Electromyographic study of reinnervated muscle and of hemifacial spasm. Am J Phys Med 1959;38:79-86. 16. Hjorth RJ, Willison RG. The electromyogram in facial myokymia and hemifacial spasm. J Neurol Sci 1973;20:117-126. 17. Deeb ZL, Jannetta PJ, Rosembaum AE, Kerber CW, Drayer BP. Tortuous vertebrobasilar arteries causing cranial nerve syndromes: screening by computed tomography. J Comput Assist Tomogr 1979;3:774-778. 18. Higashi S, Yamashita J, Yamamoto Y, et al. Hemifacial spasm associated with a cerebellopontine angle arachnoid cyst in a young adult. Surg Neurol 1992;37:289-292. 19. Nagata S, Matsushima T, Fujii K, et al. Hemifacial spasm due to tumor, aneurysm, or arteriovenous malformation. Surg Neurol 1991;38:204-209. 20. Telischi FF, Grobman LR, Sheremata WA, et al. Hemifacial spasm: occurrence in multiple sclerosis. Arch Otolaryngol Head Neck Surg 1991;117:554-556. 21. Vermersch P, Petit H, Marion MH, et al. Hemifacial spasm due to pontine infarction. J Neurol Neurosurg Psychiatry 1991;54:1018. 22. Westra I, Drummond GT. Occult pontine glioma in a patient with hemifacial spasm. Can J Ophthalmol 1991;26:148-151. 23. Gardner WJ. Concerning the mechanism of trigeminal neuralgia and hemifacial spasm. J Neurosurg 1962;19:947-957. 24. Jannetta PJ. The cause of hemifacial spasm: definitive microsurgical treatment at the brainstem in 31 patients. Trans Am Acad Ophthalmol Otol 1975;80:319-322. 25. Barker FG, Jannetta PJ, Bisonette DJ, et al. Microvascular decompression for hemifacial spasm. J Neurosurg 1995;82:201-210. 26. Kondo A. Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm. Neurosurg 1997;40:46-51. 27. Shin JC, Chung UH, Kim YC, Park C II. Prospective study of microvascular decompression in hemifacial spasm. Neurosurg 1997;40: 730-734.