Hemifacial Spasm
Hemifacial spasm (HFS) is a neuromuscular disorder resulting in frequent incontrollable muscular contractions of the face on one side. Sometimes confused with blepharospasm, HFS usually starts as uncontrollable twitching around the eye causing the eyelid to shut involuntarily. The spasm may then spread to the lower facial muscles, which does not generally occur with blepharospasm, and the patient's mouth may begin to pull to one side. Blepharospasm also tends to occur bilaterally. Benign essential blepharospasm can easily be confused with hemifacial spasm. The latter can be diagnosed through facial muscle EMG testing. Symptoms of HFS may increase with increased exposure to stress, emotional strain, fatigue, bright lights, televisions, computer monitors and reading. Hemifacial spasm occurs most frequently in middle-aged men and women.
The cause of HFS is similar to that of Trigeminal Neuralgia as a blood vessel (artery or vein) compresses a nerve coming off the brainstem in the cerebellopontine angle. However, in HFS the compression involves the facial nerve, also known as the seventh cranial nerve, as opposed to the Trigeminal Nerve as seen with Trigeminal Neuralgia. Mild cases of HFS may be controlled with Botox Injections, but recurrence is common and some patients undergo multiple injections, which can result in facial weakness, drooling, or inability to close the eye. The only curative treatment for HFS is a surgery called a microvascular decompression, which has shown to be the most effective long-term treatment for Hemifacial Spasm.
In patients who are healthy enough to tolerate surgery, microvascular decompression has shown to be the most effective long-term treatment for Hemifacial Spasm. A microscopic, microvascular decompression involves a 3 to 5 hour surgery and 2-4 day hospitalization. The procedure is performed via a small 2-3 inch opening behind the ear where a small retractor is placed to create a channel between the cerebellum of the brain and the petrous temporal bone of the skull. A microscope is then used to identify the Facial nerve and specially designed instruments are used to separate any vessels (arteries or veins) compressing the nerve. All microvascular decompression cases utilize intraoperative neurophysiological monitoring to minimize the risk of neurological injury. A small piece of Teflon felt is placed between the vessel and nerve to cushion and protect the nerve from additional compression by the vessel. The retractor is then removed and the wound is closed. Most patients awaken from surgery with their spasm gone and many resume their regular activities 2-4 weeks after surgery.
Over the past five years, Florida Hospital neurosurgeons have also been performing endoscopic microvascular decompressions as an alternative to the microscopic approach for many patients. With this approach a 1-1 ½ inch opening is placed behind the ear and a 4-mm high-definition or 3D endoscope is advanced along a corridor between the brain and skull often with no retractors necessary. The surgeon then visualizes the Facial nerve and uses specialized endoscopic microdissecting instruments to separate any compressive vessels (arteries and veins) from the nerve. A small piece of Teflon felt is placed between the offending vessel and the nerve to cushion and protect the nerve from additional vascular compression. The surgeon then advances the endoscope behind the nerve and uses angled lenses to ensure that no other compressive vessels are hiding in corners that can result in persistent spasm if missed and not decompressed. Once satisfied that the facial nerve has no more vascular compression, the endoscope is removed and the wound is closed. The duration of surgery is approximately 3 hours and most patients remain in the hospital 1-3 days. 90% of patients undergoing an endoscopic microvascular decompression with Hemifacial Spasm at Florida Hospital are note complete spasm resolution or dramatic improvement following surgery.
At Florida Hospital Neuroscience Institute, specialists will typically order a magnetic resonance imaging (MRI) scan to investigate the cause of the hemifacial spasm and determine the most appropriate treatment options. What might take months to accomplish in other settings can be completed in days at Florida Hospital.
To learn more about hemifacial spasm and our treatment options, contact us.