Treatment Challenges in Hemifacial Spasm: The Role of Magnetic Resonance Imaging.

Hemifacial spasm (HFS) is an important condition for plastic surgeons to understand, as it significantly affects patients' quality of life and can complicate aesthetic and reconstructive procedures. Magnetic resonance imaging (MRI) has become vital in diagnosing HFS, assessing neurovascular relationships, and planning treatment. Transverse MRI scans often show an upward displacement of the inferior pons at the facial nerve attachment point, signaling neurovascular compression (NVC) in HFS. Important anatomical features for neurosurgeons include cerebellar atrophy and a "small posterior fossa," which can lead to HFS by narrowing fluid spaces. The posterior fossa is often more congested in HFS patients, and anatomical flatness may exacerbate lateral deviation of the vertebrobasilar arteries. Additionally, evaluating sigmoid sinus dominance and other anatomical variations is crucial for surgical planning, particularly in cases of arterial hypertension that may affect medullary compression.