Arachnoid bands and venous compression as rare causes of hemifacial spasm: analysis of etiology in 353 patients

  • Ehab El RefaeeEmail author
  • Sascha Marx
  • Christian Rosenstengel
  • Joerg Baldauf
  • Henry W. S. Schroeder
Original Article - Functional Neurosurgery - Movement disorders
Part of the following topical collections:
  1. Functional Neurosurgery – Movement disorders



Hemifacial spasm is usually caused by arterial compression at the root exit zone of the facial nerve. However, other etiologies have been reported. The aim of this study was to analyze the frequency of other causes of hemifacial spasm.


Our prospectively maintained hemifacial spasm database containing all patients who underwent microvascular decompression (MVD) for hemifacial spasm from 2002 to 2018 was reviewed. All offending structures were identified and recorded by the surgeon at the time of surgery. Additionally, the operative videos were analyzed retrospectively.


MVD was performed in 353 patients. Arterial compression was the main cause of hemifacial spasm in 341 (96.9%) patients. Combined venous-arterial compression was seen in 7 (2.0%) patients. In one patient, the compression was from a large vein. In two patients, no compression was found. One patient who suffered from Bell’s palsy many years previously had severe synkinesis and the other had facial tics. In two patients, the spasm was caused due to strangulation of the facial nerve by arachnoid bands. Long-term follow-up of more than 18 months was available in 249 patients with total resolution or near total resolution of spasms in 89.96% of patients.


In most patients with hemifacial spasm, arterial vessels are involved in compressing the facial nerve. Purely venous compression is rarely encountered. We report for the very first time arachnoid bands strangulating the nerve as a cause for hemifacial spasm without involvement of any vessel.


Hemifacial spasm Etiology Arachnoid band Microvascular decompression Outcome Endoscope-assisted microsurgery 



The authors thank Mr Alistair Jenkins for the revision of the study and Mr. Marc Matthes for the technical assistance.

Compliance with ethical standards


The content of this manuscript has never been presented or published previously.

Conflict of interest

Henry W. S Schroeder is consultant to Karl Storz GmbH & Co. KG, Tuttlingen, Germany. The rest of the authors declare that they have no conflict of interest.

Formal consent

For our prospectively collected database, informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Ehab El Refaee
    • 1
    • 2
    Email author
  • Sascha Marx
    • 1
  • Christian Rosenstengel
    • 1
  • Joerg Baldauf
    • 1
  • Henry W. S. Schroeder
    • 1
  1. 1.Klinik und Poliklinik für NeurochirurgieUniversitätsmedizin GreifswaldGreifswaldGermany
  2. 2.Department of NeurosurgeryCairo UniversityCairoEgypt

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