As a hemifacial spasm (HFS) sufferer, you know all too well the discomfort you can experience from this condition. You may have already started researching treatment options and aren’t sure where to go from here. While there are two treatments that are regularly used for hemifacial spasm, there is only one that has proven to be highly effective for long-term relief — microvascular decompression.
What Is Hemifacial Spasm?
Hemifacial spasm is a malfunctioning of the seventh cranial nerve. This nerve controls certain muscles in your face that allow for a range of facial expressions and keeps your mouth in its naturally turned-up position. When you experience hemifacial spasm this nerve causes muscle contractions that can contort your features and even cause pain and discomfort. There are two main causes of this condition — nerve compression from an adjacent blood vessel and, more uncommonly, damage or trauma to the nerve.
Treatment Options for Hemifacial Spasm
Hemifacial spasm responds well to two different treatments — Botox injections and Microvascular Decompression surgery. Unfortunately, the first option tends to have a limited success rate and provide finite symptom relief.
Botox Injections
Botox injections provide a quick and easy means of temporary relief from hemifacial spasm. They are done on an outpatient basis and, if effective, last approximately three months. Unfortunately, the longer they’re used the less effective they become. They can also cause permanent paralysis, a risk some patients are not willing to take.
Microvascular Decompression for Hemifacial Spasm
Microvascular decompression (MVD) has become a highly sought-after treatment for facial nerve conditions such as hemifacial spasm and trigeminal neuralgia. This surgical procedure often patient provides long-term (even permanent) relief from the tics and discomfort without any of the side effects associated with Botox.
Your doctor may recommend that you consider MVD to treat your hemifacial spasm. This procedure is only performed on those that are in good health — you will need to be able to withstand general anesthesia to be a candidate. You will also need to have a FIESTA-MRI, a special imaging study that will allow your surgeon to see the structures around your seventh cranial nerve. If it is found that your hemifacial spasm is being caused by compression from a blood vessel, then you are probably a good candidate for this surgery.
Pre-Operative Preparation
Because MVD is an anesthetic procedure, you will likely need to have a blood panel done to monitor your organ function, blood sugar and blood cell count. Your surgeon can write you a referral or you may be able to have your blood drawn for these tests in his or her office. When preparing for this surgery, you should also expect to need some help once you return home. This includes driving, housework and meal preparation for at least the first week or two.
On the morning of your operation, you will check in at the hospital. You’ll be admitted and taken to the surgical preparation area. Here they will give you a gown to change into, insert an IV and, if needed, give you a sedative. You’ll also meet with your surgeon and anesthesiologist and go over the surgical plan.
Procedure
Once you’ve been taken into the operating room and are under general anesthesia, your surgeon will begin. He or she will make a small incision in your scalp about an inch behind the ear. The skin will be moved back, and a piece of bone approximately the size of a quarter will be removed. This will allow access to the seventh cranial nerve and the blood vessel that is compressing it. With specialized instruments including a surgical microscope, the nerve and vessel will be located. Your surgeon will then note the point or points where they are touching and will place tiny Teflon pads in those locations. This provides a buffer between the two structures and keeps the vessel from being able to irritate the nerve. Once the nerve function has been tested, your skull will be closed and the skin sutured back into place.
Recovery
As soon as your surgery is over, you will be moved to the recovery area. Here your vitals will be monitored and your pain medications adjusted. Once you’re awake and your vitals are remaining stable, you’ll be taken to the ICU for overnight observation. It is not uncommon to be asked to get up and walk around.
After one day in a standard hospital room you will likely be well enough to go home and continue your recovery. It is possible to spend up to three days in the hospital, depending on each individual case. During this time, you’ll be transitioned to oral pain medications and, in some cases, given special exercises to continue at home.
When you are released, be sure to have arranged for transportation — you won’t be able to drive yourself home. Once there, take it easy. Get plenty of rest. It is also helpful to take several short walks throughout the day to promote circulation and keep your muscles toned.
By the second or third week, you should be feeling more energetic. You will be finished with your pain medication and can start resuming some of your normal activities. If you work in a light-duty occupation, you can return to work during this time. More strenuous jobs will require that you wait a little longer for further healing.
Between the fourth and sixth weeks, you’ll need to follow up with your surgeon. This appointment will usually be scheduled before you leave the hospital. Be sure to attend all follow-ups to allow your progress to be monitored and address any issues that may arise.
Full recovery from your MVD can be expected by around the sixth month after surgery.
Why MVD Is the Top Treatment Option
The effectiveness of this procedure has proven to be more than just a stopgap — it can completely alleviate the symptoms of hemifacial spasm. It also allows patients to maintain all facial sensation and avoid the use of neurotoxins such as Botox to arrest muscle response.
The success rate for MVD is very high — an estimated 92 percent of patients receive complete relief after having this procedure done.
