Hemifacial spasm in young people treated with microvascular decompression of the facial nerve

Hemifacial spasm (HFS) in childhood is extremely rare. Two patients with HFS in childhood and eight adults who had the onset of HFS before the age of 20 were treated with microvascular decompression of the facial nerve at the nerve root entry zone. The two children were both girls and had typical HFS on the right side. Of the eight adults, five were men and three were women. Six had typical and two had atypical HFS. Six had HFS on the left side, and two had HFS on the right. Vascular cross compression was found at the nerve root entry zone in all cases. The average follow-up period was 7.3 years (range, 1 1/2 to 11 years). All but one patient had complete relief of their HFS immediately or after delay. In one adult, the compressing artery could not be decompressed without damaging the nerves. One adult patient had two recurrences 1 year after the first operation and 6 months after the second; this patient had complete relief after a third operation. Complications included temporary mild facial weakness in four patients and moderate hearing impairment in the patient who had three operations. These results are comparable to those of HFS of adult onset. Microvascular decompression is recommended as the treatment of choice for HFS during childhood.