Technical Difficulties of Microvascular Decompression Surgery for Hemifacial Spasm

Hemifacial spasm (HFS) is referred as a truly surgical disorder that microvascular decompression (MVD) plays a major role in treatment. Medication and botulinum toxin are frequently used in outpatient clinics without long-lasting efficacy. Although we do not fully understand the pathophysiology of HFS, there may be unrevealed explanations for the unsolved patients, about 10% of the patients, by MVD; those explanations are not merely the compression at the root exit zone of the facial nerve by the offending vessel. Moreover, surgical difficulty can be another explanation for the MVD failure, and we share our experiences of the most surgically demanding cases in patients with HFS during MVD.