Microvascular Decompression

Brain surgery to separate a blood vessel from a compressed cranial nerve, potentially curing hemifacial spasm.

Microvascular decompression (MVD) is a surgical procedure that separates a blood vessel from a cranial nerve it's compressing. For hemifacial spasm, it can be curative by relieving pressure on the facial nerve.

Key Takeaways

Potentially curative for hemifacial spasm
Brain surgery under general anesthesia
Separates blood vessel from nerve
High success rate (85-90%)
Alternative to lifelong Botox

How It Works

A blood vessel (usually an artery) pressing on the facial nerve at its exit from the brainstem causes hemifacial spasm. Surgery places cushioning material between the vessel and nerve to eliminate the compression.

Who Is a Candidate

Confirmed hemifacial spasm
Botox not working or not desired
Willing to accept surgical risks
Good general health
MRI shows vascular compression

The Procedure

Before Surgery

MRI confirms vascular compression
General health evaluation
Stop blood thinners

During Surgery

General anesthesia
Small incision behind ear
Open skull (craniotomy) to access nerve
Identify compressing vessel
Place Teflon cushion between vessel and nerve
Takes 2-3 hours

After Surgery

ICU monitoring initially
Hospital stay 2-5 days
Recovery over weeks

Success Rates

85-90% immediate relief
Some have delayed improvement
Small percentage relapse
Cure often permanent

Risks

Hearing loss (1-5%)
Facial weakness (temporary or permanent)
CSF leak
Stroke (rare)
Infection
Anesthesia risks

Compared to Botox

MVD Surgery	Botox Injections
Potentially curative	Ongoing treatment needed
One-time procedure	Every 3-4 months
Surgical risks	Minimal risks
Hospital stay	Office procedure

Medically Reviewed Content

This article meets our editorial standards

Written by:: Hashemi Eye Care Medical Team
Medically reviewed by:: Board-Certified Neuro-Ophthalmologist (MD, Neuro-Ophthalmology)
Last reviewed:: January 30, 2025

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