A Face of Relief: Microvascular Decompression at Christian Hospital Solved Patrick’s Uncontrollable Twitching

One word immediately comes to mind when Patrick Simpson describes how it felt to live with facial spasms and the challenges they caused: “annoying.”

The nervous system condition that causes muscles on one side of the face to twitch or tighten without control didn’t cause pain, but it created plenty of problems, especially as the symptoms intensified over time.

Hemifacial spasm, Patrick’s official diagnosis, made his left eye twitch and tighten. It often appeared as if he was intentionally winking. What started as an awkward, uncomfortable occurrence eventually became a nuisance that affected every aspect of his life.

Before retiring, Patrick, 67, worked in welding and maintenance. When his eye squeezed shut, his vision suffered. Projects took longer and became harder.

“I would have to really work hard at keeping my left eye open, or even physically pull it back open,” Patrick says. “If I wanted to see something well on my left side, I’d have to turn and look with my right eye.”

Driving made him nervous. He stopped wearing contact lenses because a spasm could cause the left one to fall out. Even reading text on his cell phone became a burden because the movement of his face often scrambled his focus. He also encountered quizzical looks from others.

“It was noticeable,” Patrick says. “People would never ask about it, but they wondered. And people who knew me were concerned.”

Searching for relief

After Patrick’s condition was diagnosed in 2019 by another health system, he tried medication. Muscle relaxants or seizure medications are often used to treat hemifacial spasm. The first medicine Patrick tried brought him no relief.

Patrick then started botulinum toxin, or Botox®, injections. This treatment, which targets affected areas with medication that temporarily weakens overactive muscles, worked. But the shots didn’t solve the root of the problem, and their effectiveness faded over time. Once every six months for more than five years, Patrick sat through injections in his forehead and around his eyes, cheeks, and lips.

“The shots were painful,” he says. “I got tired of doing them. It was time to find someone good and get something done that lasted.”

A lasting solution

After his retirement prompted him to reconsider treatment options and what his insurance would cover, Patrick went online to search for a permanent answer, scanning the internet for highly reviewed doctors experienced in treating his condition, preferably someone who was close to his home in Greenup, Illinois.

Repeatedly, he found feedback from pleased patients of Kumar Vasudevan, MD, a board-certified WashU Medicine neurosurgeon at Christian Hospital.

Patrick made a phone call and things moved quickly. Dr. Vasudevan ordered new scans of Patrick’s brain and met with him at Christian Hospital to review the images. Patrick left that consultation with the most complete understanding of his condition since his initial diagnosis. 

Like most people with hemifacial spasm, the cause of Patrick’s condition was a blood vessel pressing against a facial nerve inside his skull. The nerve controls the muscles used for blinking, smiling, and other facial movements. As a blood vessel transports blood throughout the body, it moves slightly and touches this nerve, irritating it and prompting incorrect signals to be sent, leading to muscle twitching. Without a surgical solution, Patrick would continue to experience involuntary facial twitching. Every beat of his heart was a potential trigger.

Why, specifically, Patrick experienced hemifacial spasm is uncertain. His situation mirrored what many with the condition go through. The condition often starts without something sudden or dramatic causing it, then develops gradually over time. 

Dr. Vasudevan suggested that Patrick undergo a surgical procedure called microvascular decompression. The procedure addresses the root cause of hemifacial spasm by relieving pressure on the affected facial nerve. The cranial surgery is the most effective long-term treatment for hemifacial spasm, and many patients experience significant improvement or complete relief after the surgery.
 

“He showed me where the problem was and how he would fix it,” Patrick says. “He went through it all with me, explaining it very thoroughly. I told him I was ready to get it done.”

 A complete cure

Dr. Vasudevan completed the microvascular decompression on Sept. 3, 2025, less than a month after Patrick’s initial trip to Christian Hospital.

After shaving a small patch of hair near Patrick’s left ear, Dr. Vasudevan made a small opening in the skull behind the ear to access the facial nerve. He gently moved the problem-causing blood vessel and inserted a permanent pad made of Teflon mesh to keep the two from touching one another. The pad stays in place permanently and the body heals itself around it. Patrick was under general anesthesia during the operation, meaning he was fully asleep and felt nothing.

As is often the case following the procedure, Patrick was awake and in no pain the same day of his surgery. The next day, he passed the motor skill tests and follow-ups required to be discharged. He expected to be in some pain following his surgery. It never came. The positive results were immediate and impactful. His face spasms were gone, as if they had never affected him in the first place.

“Patrick’s story is typical of many of the patients who have this condition,” Dr. Vasudevan says. “Hemifacial spasm and trigeminal neuralgia—a condition caused by vessels compressing nerves that is also treated with surgery—are relatively uncommon.  Sometimes it can take a while to make the correct diagnosis, and many patients with debilitating symptoms do not realize that they can often be completely cured with surgery. We are so happy that Patrick had an excellent result.”

Today, the only reminder of Patrick’s condition is a small scar near his left ear. He’s symptom-free.

“It was just instant recovery and relief,” he says. “I see better and have increased confidence in everything I do. I should have done it sooner. Life would have been a lot more pleasant if I did.”

 Learn more about BJC HealthCare’s neurological care. Call 314-747-9355 to make an appointment.

Frequently asked questions about hemifacial spasm and microvascular decompression 

What is hemifacial spasm?
A hemifacial spasm is a nervous system condition that causes muscles on one side of the face to twitch or tighten without control. The spasms affect only one side of the face. These movements are not painful, but they can be uncomfortable and embarrassing. Twitching often becomes more frequent over time.

How is hemifacial spasm diagnosed?
Hemifacial spasm can be diagnosed through medical history, physical examination, and imaging scans. Doctors can often diagnose it based on symptoms alone. 

Your doctor may ask the following questions: 

• When did the twitching start?
• How often does it happen?
• Which muscles are involved?

What are treatment options?
Muscle relaxants, seizure medications, or Botox® injections are among common treatments that reduce twitching by relaxing facial muscles, but they must be repeated and do not address the underlying cause of hemifacial spasm. Microvascular decompression surgery is the only treatment that addresses the cause of the condition by relieving pressure from a blood vessel on the facial nerve.

What type of doctor treats and diagnoses hemifacial spasm? 
Hemifacial spasm is treated by neurologists and neurosurgeons who specialize in nervous system and movement disorder conditions. Neurologists often are the first to diagnosis the condition, but some neurosurgeons can, too. If microvascular decompression is recommended, the surgery is performed by a neurosurgeon, a specialist in brain and nerve surgery.

Is microvascular decompression a type of cranial surgery? 
Yes, because the procedure, which is performed by a neurosurgeon, involves making a small opening in the skull to reach a nerve near the brainstem. The neurosurgeon makes a small opening behind the ear, which allows access to the facial nerve inside the skull, where a blood vessel is creating pressure.

Does the neurosurgeon operate on the brain during the procedure? 
No. While microvascular decompression is cranial surgery, the brain tissue itself is not cut or removed. The neurosurgeon’s goal is to gently move a blood vessel away from the nerve, then insert a small cushion between the two to prevent pressure.

Are patients awake during the procedure? 
No. Microvascular decompression is done under general anesthesia. Patients are fully asleep for the entire procedure. They do not feel pain or remember the surgery. 

How common is microvascular decompression? 
It’s a well-established procedure used to treat hemifacial spasm and is considered the most effective long-term treatment for many patients.

How invasive is microvascular decompression?
The procedure is less invasive than most cranial surgeries. The incision and opening in the skull are small. Most patients get out of bed within a day after surgery.