Surgical treatment of hemifacial spasm: a systematic review

The annual incidence of hemifacial spasm is 8-15 cases per 100.000. This disease is not life-threatening, but it significantly impacts the quality of life. Primary treatment is vascular decompression of the facial nerve. Thus, improvement of appropriate technique is crucial for higher efficacy and safety. OBJECTIVE: To determine the optimal algorithm for vascular decompression according to available international experience in surgical treatment of hemifacial spasm. MATERIAL AND METHODS: A systematic review was conducted in accordance with the PRISMA guidelines. To identify relevant publications, we screened the PubMed, Google Scholar, and eLibrary databases through October 2024 using the keywords «microvascular decompression» and «hemifacial spasm». Only full-text articles in Russian, English, or French were included in the study. RESULTS: Among 364 manuscripts, 24 met the inclusion criteria. The majority of studies demonstrated available experience and effectiveness of vascular decompression without description of surgical approach. CONCLUSION: Considering global experience, we proposed an optimal surgical algorithm, including initial dissection of bulbar nerves and facial nerve decompression, if possible, along its entire length.