Putting a Stop to Facial Spasms
Surgery at Atlantic Health System finally cured Christina S.’ facial spasms. She only wishes she knew about the treatment sooner.
Christina, an avid concertgoer, is back in action now that her struggle with facial spasms is behind her.
For most people, eye twitching every now and then isn’t uncommon or cause for concern. When the contractions become chronic and start spreading to other areas of the face, it is.
Over the past decade, Christina S. from Summit, New Jersey, noticed her lower left eyelid twitching sporadically. She would rub her eye, the spasm would go away and it wasn’t much of a bother. Then the twitching became much more frequent and apparent across her face.
“Sometimes I could feel my eye twitching. Other times, people would see it and tell me because they could tell I didn’t know it was happening,” explains Christina. “Things got worse from there. I distinctly remember being at home one day, and all of the sudden, it wasn’t just my eye that was twitching. My whole face, from my eyes to my lips, was spasming. This went on for about 10 minutes.”
It happened again the next day, with multiple episodes lasting 10 to 15 minutes. Christina’s doctor told her to go to the emergency room. At Atlantic Health System’s Overlook Medical Center, an initial MRI scan appeared negative and did not identify an obvious cause, such as a stroke or brain tumor.
The Root of Hemifacial Spasms
For further review, the neurology team connected Christina with Atlantic Brain and Spine Neurosurgeon Yaron A. Moshel, MD, PhD, who serves as Associate Medical Director of Neurosurgery for Atlantic Health System. On close inspection of her MRI, Dr. Moshel identified a small blood vessel loop pressing on the area where the facial nerve exits the brainstem.
“Hemifacial spasm is a very rare condition that causes chronic spasming of the face on one side. While it is not painful, it is extremely disruptive and often causes patients to develop social anxiety or become socially isolated,” Dr. Moshel explains. “There are some medications that can help, and in some instances, Botox can provide relief. When the spasms are caused by nerve compression at the brainstem, as in Christina’s case, they can be cured with microvascular decompression surgery.”
Christina, who had an unrelated surgery months earlier to clear a clogged carotid artery, was initially hesitant about having another procedure.
“I sat down with Dr. Moshel and asked him a million questions,” she says. “He explained the whole surgery in detail, and I felt really good when I left his office. I just wasn’t ready to move forward with the surgery yet. But after a few months, I couldn’t handle it anymore. I couldn’t sleep. I felt like people were looking at my face instead of at me. I just had enough.”
An Exacting Approach to Microvascular Decompression
Christina proceeded with microvascular decompression surgery. During this operation, Dr. Moshel used MRI-based computer guidance to navigate and plan the most minimally invasive and strategic approach to alleviate the pressure on Christina’s facial nerve.
“For the surgery to be effective and avoid causing other issues, it had to be performed with extreme precision,” explains Dr. Moshel. “If the operation was approached from a suboptimal angle, it could have left Christina dealing with facial spasms or even have led to hearing loss.”
A small incision was made behind Christina’s ear, which enabled the surgical team to reach the front of the brainstem from an ideal angle by temporarily removing the bones deep in the ear. This type of skull base approach avoids the manipulation and retraction of the brain that is typical with traditional techniques.
“We can always reconstruct bone, but it’s not possible to repair damaged brain tissue,” Dr. Moshel says.
With access to the root entry zone – a small, very specific area under the nerve and to the side of the brainstem – he was able to delicately move the problematic blood vessel. He surrounded it with a Teflon sponge to prevent it from springing back onto the brainstem in the future.
“It’s amazing that we can do all this so precisely with the technology we have through an incision that’s just an inch and half long,” notes Dr. Moshel. “Our advanced microscopes, endoscopic cameras and microsurgical instruments in the hands of a dedicated team of experts – including neurophysiologists who consistently monitor nerve function during surgery – make this possible.”
“I was in and out of surgery in a few hours, and it gave me my life back. I only wish I knew about it sooner,” says Christina. “A lot of people who have facial spasms think it’s just part of life. The truth is, it doesn’t have to be.”
