Hemifacial Spasm Surgery

"He really helped me a lot...I can go for days without symptoms now," says Ruby Marruquin
It started nine years ago with an occasional twitch in Ruby Marruquin’s left eye. As time went on, the twitching became more frequent, severe and painful.

“By the time I started looking for help, it was pulling the left side of my face up to my eye, which would close completely,” the 68-year-old Indio resident recalls. As a result, she couldn’t drive, her sleeping was disturbed, eating was a challenge, and social interaction was extremely difficult.

Marruquin had a condition called hemifacial spasm (HFS), a neurological disorder in which muscles on one side of the face involuntarily contract, causing sporadic, uncontrollable contortion of the face. It’s usually caused by a blood vessel that compresses the facial nerve where it exits the brainstem. The facial nerve controls the muscles of facial expression.

HFS typically begins in the muscle surrounding the eye and can spread to involve other muscles on the same side of the face. Spasms can worsen over time, leading to nearly constant disfigurement with a grimacing expression. The condition can also worsen in times of stress and fatigue.

“I saw several doctors, but the only treatment they offered me was Botox®,” Marruquin says, referring to botulinum toxin, a bacterial toxin injected into facial muscles; it paralyzes the muscles so they don’t move. However, it is only a temporary solution.

“I had to go back every three months for treatment,” she says, “but the spasms continued to get worse, pulling all the way from my neck to my eye.”

Then, about two years ago, Marruquin developed a heart problem and needed to have a pacemaker implanted. This device, which regulates heart rhythm, is placed under the skin near the collarbone on the left side of the chest.

“The spasms then started pulling from there upward, and I was concerned,” she says. “So I saw a neurologist who recommended I see a neurosurgeon who could do surgery for this condition. Other doctors had said there was no surgery for this.”

Neurologist Indermohan Luthra, MD, recommended Board Certified Neurosurgeon Farhad Limonadi, MD, Director, Neurosurgery, Eisenhower Neuroscience Institute. He specializes in brain tumors, minimally invasive spinal surgery, trigeminal neuralgia, facial pain, aneurysms, deep-brain stimulation, and complex spine and chronic pain syndrome.

"it's important for people with hemifacial spasm to know there are surgical options which are quite successful."Farhad Limonadi, MD
“Surgery really is the best option for treating the underlying cause of hemifacial spasm,” Dr. Limonadi says. “While Botox may provide some short-term symptom relief, it has side effects such as sagging and weakness of the muscle. And Ms. Marruquin’s spasms were intensifying in duration and frequency, so this conservative approach had failed.”

The procedure Dr. Limonadi performed is called a retrosigmoid craniotomy with microvascular decompression. It’s a microsurgical intervention performed under a surgical microscope.

“We make a small, quarter-sized entry in the back of the head, on the same side as the spasm, and essentially sneak by the cerebellum and get to the nerve and brainstem,” he explains. “We find the artery that’s pressing on the nerve, separate it from the brainstem and nerve, and place a Teflon™ insulator (a small sponge-like pad) between them.”

It typically takes six months to see meaningful improvement of HFS symptoms after surgery, but Marruquin’s symptoms began to improve almost immediately. This surgery can be viewed at https://www. youtube.com/watch?v=zHoZp3dSvS8 and https://www. youtube.com/watch?v=HRNPCQiDoV4.

“Ms. Marruquin can drive again, and the facial twitching is dramatically reduced,” Dr. Limonadi says. “The improvement is remarkable.”

“He really helped me a lot,” she says. “I can go for days without symptoms now.

“I’ve also seen two other women who had the same kind of twitching,” she continues. “I went up to them and said, ‘Not to be nosy, but I know what you’re going through, and here’s Dr. Limonadi’s card. He’s done so much for me.’” “It’s important for people with hemifacial spasm to know there are surgical options which are quite successful,” Dr. Limonadi adds. “People don’t have to live with the facial pain or severe twitching that affects quality of life.” He also credits Dr. Luthra for an appropriate diagnosis and proper management of Marruquin.

“A lot of doctors don’t recognize this condition,” Dr. Limonadi says. “But he managed it responsibly and referred responsibly.”

To contact Eisenhower Neuroscience Institute, call 760.837.8020.