title: Hemifacial spasm and neurovascular compression.
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.
authors.affiliation: Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06520, USA.
authors.forename: Alex Y
authors.initials: AY
authors.lastname: Lu
authors.affiliation: Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06520, USA.
authors.forename: Jacky T
authors.initials: JT
authors.lastname: Yeung
authors.affiliation: Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06520, USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Gerrard
authors.affiliation: Section of Otolaryngology, Yale School of Medicine, New Haven, CT 06520, USA.
authors.forename: Elias M
authors.initials: EM
authors.lastname: Michaelides
authors.affiliation: Hamot Hospital, University of Pittsburgh Medical Center, Erie, PA 16507, USA.
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Sekula
authors.affiliation: Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06520, USA.
authors.forename: Ketan R
authors.initials: KR
authors.lastname: Bulsara
mesh_terms: D000328:Adult; D017668:Age of Onset; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D019299:Decompression, Surgical; D004576:Electromyography; D005154:Facial Nerve / Q000098:blood supply / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019569:Hemifacial Spasm / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D009465:Neuromuscular Agents / Q000627:therapeutic use
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C545476:incobotulinumtoxinA