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The Scientific World Journal
Volume 2014, Article ID 349319, 7 pages
http://dx.doi.org/10.1155/2014/349319
Review Article

Hemifacial Spasm and Neurovascular Compression

1Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06520, USA
2Section of Otolaryngology, Yale School of Medicine, New Haven, CT 06520, USA
3Hamot Hospital, University of Pittsburgh Medical Center, Erie, PA 16507, USA

Received 4 July 2014; Revised 19 September 2014; Accepted 24 September 2014; Published 28 October 2014

Academic Editor: Robert M. Starke

Copyright © 2014 Alex Y. Lu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Its prevalence is 9.8 per 100,000 persons with an average age of onset of 44 years. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone of the facial nerve. HFS can be divided into two types: primary and secondary. Primary HFS is triggered by vascular compression whereas secondary HFS comprises all other causes of facial nerve damage. Clinical examination and imaging modalities such as electromyography (EMG) and magnetic resonance imaging (MRI) are useful to differentiate HFS from other facial movement disorders and for intraoperative planning. The standard medical management for HFS is botulinum neurotoxin (BoNT) injections, which provides low-risk but limited symptomatic relief. The only curative treatment for HFS is microvascular decompression (MVD), a surgical intervention that provides lasting symptomatic relief by reducing compression of the facial nerve root. With a low rate of complications such as hearing loss, MVD remains the treatment of choice for HFS patients as intraoperative technique and monitoring continue to improve.