Hemifacial spasm is perhaps the most grotesque and socially disabling condition caused by nerve compression. Embarrassment and social isolation lead to withdrawal and depression. Severely affected patients may even contemplate suicide.

Luckily, this can be cured with the help of advanced neurosurgery. However, focused efforts and execution of these surgeries was not possible in India before the Synapse Brain and Spine Foundation took this up as a project.

As a team we have performed more than 250 surgeries to treat this disorder, from which tens of thousands of patients suffer. The only permanent solution is brain surgery, which is done in a very deep area. Ability to visualize deep and hidden objects is only possible through state-of-the-art technology and equipment.

This unique project will be immensely helped, and results boosted, through the ongoing Neuromicroscope Project.

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What are Hemifacial Spasms?

In essence they are repeated, uncontrolled contractions of facial muscles on one side of the face. Spasms usually appear when the patient starts talking. They can also occur at other times. See Video.

What are the symptoms of Hemifacial Spasm?
(How do the spasms appear to the observer?)

One side of the person's face appears to be repeatedly contracting. It usually starts in the muscles surrounding the eye. The eye shuts and opens again repeatedly.

Slowly the cheek on that side also starts to contract repeatedly. Angle of the mouth gets pulled to the same side.

For an observer, it appears as if the person is repeatedly winking with that eye and making obscene facial gestures.

The disease is generally progressive and as the days and months pass by, the spasms appear as soon as the person starts talking.

What is the cause of HFS?

Hemifacial spasms can occur due to a variety of problems.

The commonest and most effectively treatable cause is the compression of the nerve by a blood vessel at a very vulnerable area called the root exit zone (REZ). This is the area where the nerve exits from the brainstem (lower part of the brain).

Some people genetically have blood vessels close to this region and as the age advances, these blood vessels elongate and become torturous. (increase in length and curve). This is also called as the process of progressive "ECTASIA".

Such elongation occurs in every person with age, but in HFS patients, this causes the already close blood vessel to progressively compress or 'burrow" into the REZ region of the nerve. This, in turn, causes persistent pulsatile compression of the nerve leading to internal changes in the nerve (demyelination). This actually causes hemifacial spasms.

When a progressively elongating artery has lodged and burrowed into the facial nerve, it continuously beats against the nerve fibres causing damage by progressive demyelination. It has been proven that this indeed happens.

This also explains why, when the offending blood vessel is gently moved away and kept separated (as is done in MVD surgery) the hemifacial spasms disappear.

So, can any other compression cause HFS?

The answer is yes... rarely, compression of the REZ by tumours (growths) can cause HFS, but it is rare as compared to a blood vessel pressing on the REZ. In our research study we found that even if a tumour is causing HFS, it usually does so by pushing a blood vessel against the nerve.

Another question that comes forth is ‘are there non-compressive cause of HFS?

Facial nerve trauma or Bells’ palsy followed by internal nerve repair by the body can, occasionally lead to HFS.
Old stroke, head injury, multiple sclerosis are other uncommon causes.

What is the Treatment?

At the MVD center supported by Synapse Brain and Spine Foundation by acquiring advanced equipment for these difficult surgeries, we believe in aiming at permanently curing the hemifacial spasms. This is done with microvascular decompression surgery (MVD Surgery).

Compression by a blood vessel on the facial nerve is the commonest cause of hemifacial spasms. Longer the period for which the artery is allowed to beat against the nerve, more will be the severity of the spasms and worse will be the chances of complete cure by MVD surgery.

So, considering a long-term perspective, we feel that MVD surgery should be performed rather early in the course of the disease.

What steps are to be taken before surgery to treat Hemifacial spasm?

Once a clinical diagnosis of hemifacial spasm is made, the typical course is to check if a vessel compression is the cause of the spasms, by performing specific sequences on high quality MRI Machine to study the nerve in the REZ region. Some blood investigations will also be needed.
Final step is actually performing MVD surgery.

Any other treatment options?

There is no other treatment which removes the basic cause of the spasms. Also, the treatment with botulinum toxin (Botox) is short lived and does not remove the basic cause of the problem. It has no potential of offering permanent cure.

MVD, on the other hand has a very high chance of offering permanent cure (more than 98%) when the selection is done meticulously.

Why do we not prefer BOTOX to treat hemifacial spasms?

Botulinum toxin (Botox) is actually a toxin (poison) from bacteria. It is injected in the twitching muscles and it causes incomplete paralysis of the face. So, the spasms stop temporarily for about 3 months. The problems of mask-like face after injection and very short duration of effect are real.
But more importantly, the blood vessel compressing the nerve is silently causing progressive damage & demyelination. The spasms come back with increased intensity, sabotaging the possibility of permanent cure by MVD.

And therefore, we believe in early MVD.

How is MVD surgery performed for HFS?

This surgery is performed under general anaesthesia.

A small incision behind the ear within the hairline is used. To be successful, the surgery needs a top-quality Neuro Microscope and thin Endoscopes which can be used inside brain.

In essence, the offending, compressing blood vessel is carefully dissected off and dislodged from the REZ and is kept separated by Teflon sponge.
The surgery typically takes three hours at our MVD center.

A highly trained team, a neurosurgeon experienced in this surgery and top class equipment are desirable. The spasms stop totally and immediately in most cases (in 90 percent according to our study) and in others slowly go-on reducing over next fifteen days or so and then disappear in the remaining 9 percent...WITH THE FINAL SUCCESS RATE OF 99 PERCENT.

Typical hospitalization time after surgery is three to four days. Ambulation is allowed twenty four hours after surgery.

What are the results of MVD surgery done for hemifacial spasms?

In our personal series of 252 patients, operated between the year 2006 to 2020, by the same team at Synapse Brain and Spine Foundation with the same assisting and anaesthesiologist’s team, 99% had complete relief (follow up 7 months to 14 years) and 1% had remarkably improved status.

In short, MVD surgery for treatment of HFS in the modern age is reasonably safe, effective and dramatic. Surgery has the potential of curing the hemifacial spasms.

Why has a specific center been developed for MVD surgery to treat HFS?

The results of MVD surgery tend to be far better when careful diagnosis, selection and work-up has been done. Also, this peculiar surgery, needs a neurosurgeon and team highly experienced in this operation, due to various factors.

With these considerations, this center for MVD surgery was established. Till date we have performed more than 1350 MVD surgeries (together for trigeminal neuralgia, Glossopharyngeal neuralgia and hemifacial spasms), with the same team of assistants and anesthesiologists.

What are the factors determining success?

In our opinion, this surgery is likely to be very successful if

1)Patients are carefully chosen (eg: Post facial nerve injury HFS or post stroke HFS patients should be strictly excluded, syndromes which look similar to HFS should be excluded etc)

2)The same team operates on the patient. The success rate is likely to be higher if a neurosurgeon and team experienced & interested in this surgery performs the surgery.