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Treating Hemifacial Spasm
Hemifacial spasm (HFS), also known as unilateral facial muscle spasm, is a rare yet distressing condition. Patients experience involuntary twitching of the eyebrow, which begins at the lower or upper eyelid and gradually spreads to the cheek and corner of the mouth. This involuntary movement typically affects only one half of the face.
As time progresses, the symptoms intensify and have a significant impact on the patient's social life and mental health. With the worsening of the condition, the patient's facial muscles frequently spasm uncontrollably, even in public settings, causing considerable psychological distress and social difficulties.
The main treatment options include:
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Oral Medication: Anti-spasmodic drugs are used to alleviate symptoms, though their effectiveness is limited and they are primarily used for mild or initial cases.
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Botulinum Toxin Injections: Administered every three months into the eyelids and facial muscles, these injections can effectively reduce symptoms but do not cure the underlying cause. While this method provides temporary relief from muscle spasms, it requires regular repetition.
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Minimally Invasive Neurosurgery: Microvascular decompression surgery of the facial nerve is considered the most definitive treatment. The surgery involves relocating the blood vessels compressing the facial nerve, thereby relieving nerve pressure and aiming for a cure. This surgery is typically performed under general anesthesia and includes continuous intraoperative nerve monitoring to ensure safety.
A patient who underwent minimally invasive neurosurgery experienced significant symptom improvement. Post-surgery, over 90% of the tumor was successfully removed, and the uncontrollable facial muscle spasms were fundamentally controlled, markedly improving the patient's social interactions and psychological state. The patient was satisfied with the treatment results and gradually returned to normal life.
This case demonstrates that minimally invasive surgery for hemifacial spasm not only effectively treats the disease but also significantly enhances the quality of life for patients.
Picture showing right sided hemifacial spasm with severe tic in causing contracted eyelids and leading to the appearance of smaller eye. Facial muscle twitching at cheek and angle of mouth leading to appearance of facial asymmetry.
Detailed MRI revealed the right facial nerve was impinged by a tiny vascular loop to cause severe right sided eye & muscle twitching.
Picture showing sites of Botox injection for 3 months temporary symptomatic control of severe hemifacial spasm.
Picture showing the use of a 3cm small wound behind hairline at the back of the ear for the minimally invasive brain surgery, i.e. microvascular decompression surgery for releasing the compressed facial nerve.
Picture showing that under microscope，the facial nerve at brainstem was found to be impinged by a small vascular loop.
Animation showing how the facial nerve is decompressed from the impinging vascular loop.
The facial nerve is decompressed from the impinging vascular loop and is separated and isolated from it with using a Telfon felt.
Left: Under microscope, the facial nerve at brainstem was found to be impinged by a small vascular loop.
Middle: The facial nerve at its root exit zone at brainstem is now freed from any impinging vessels.
Right: Under microscope, the facial nerve was decompressed from the impinging vascular loop and was separated from it with using a Telfon felt.
Left: Under microscope, the facial nerve at brainstem was found to be impinged by 2 small vascular loops.
Middle & Right: Under microscope, the facial nerve was decompressed from the impinging vascular loop and was separated from it with using a Telfon felt.