Hemifacial spasm is characterized by frequent involuntary twitching of one side of the face. This
twitching or spasm usually starts around the eye and slowly progresses to involve the lower face. The muscles in the
forehead and neck are usually the last to be affected. Most often, hemifacial spasm is caused by a blood vessel pressing
on the facial nerve at the point where the nerve exits the brainstem.
UPMC neurosurgeons are among the most experienced in the U.S. in treating hemifacial spasm with
Microvascular Decompression, which alleviates the spasms by moving the blood vessel away from the nerve. Our
surgeons have refined this procedure since first implementing it nearly 40 years ago. Today, UPMC neurosurgeons perform
approximately 75 microvascular decompressions for hemifacial spasm each year, with 92 percent of patients experiencing complete
relief or dramatically improved symptoms. Surgery causes significant complications in fewer than 5 percent of cases.
Your doctor will perform a physical exam and will ask about any symptoms you are having.
Symptoms may include:
- An intermittent twitching in the eyelid muscle, which can lead to forced closure of the eye
- This spasm may gradually spread to the muscles of the lower face, which may cause the mouth to be pulled to one side.
- In rare cases, doctors may see individuals with spasm on both sides of the face.
At UPMC, the treatment of choice for severe hemifacial spasm is Microvascular Decompression. Advances in
instruments and techniques has made this treatment option more effective in recent years.
Microvascular decompression is a surgical procedure that relieves abnormal compression of a cranial nerve. The
surgery consists of a linear incision behind the ear followed by a craniectomy (bony opening) the size of a silver
dollar. Under the view of a microscope or endoscope, the surgeons detect the area where the blood vessel is affecting
the nerve and then separate them, leaving a Teflon "pillow" in between.
During surgery, the surgeons monitor facial nerve irritability to identify the blood vessel causing the nerve
compression, making cure more likely. Monitoring also helps surgeons to avoid damaging hearing and facial nerves.
Our surgical team sometimes uses endoscopes that allow them to look around corners as they operate, identify hidden
blood vessels, and minimize the impact on sensitive brain tissue.
About 75 microvascular decompressions for hemifacial spasm are performed at UPMC each year, with 92 percent of
patients experiencing complete relief or dramatically improved symptoms. Surgery causes significant complications
in fewer than 5 percent of cases.