Facial muscle spasm is just a twitching of the face, which is unpleasant and not life-threatening, so it is not a major disease, so why do we need a drastic surgery? Is the surgery a big opening? The first thing you need to do is to open up your face and break your face. First of all, although facial myospasm is not life-threatening, it affects the quality of life and self-esteem of patients, and if not treated thoroughly, it will be accompanied by lifelong and slowly aggravated; secondly, the only way to cure facial myospasm – microvascular decompression, a minimally invasive surgery to completely solve the pain of the disease (for details, see the article series The only radical cure for facial myospasm – microvascular decompression”). Take a look at the following illustrated procedure and you will see that it is not drastic, much less broken. Zhu Hongwei, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University ① Removal of hair from the surgical area: The nurse will remove a portion of the patient’s hair behind the ear before surgery in order to expose the surgical field. If the patient’s hair is particularly long, such as shoulder-length or even waist-length, it is not necessary to shave the whole head, considering that all of it will affect the patient’s appearance, but only the hair around the surgical area (roughly a circle of 15 centimeters in diameter); if the patient has short hair, especially for men, then eliminating all of it will not have much effect, and the hair will grow back after a while after the surgery. ② Incision behind the ear: Microvascular decompression surgery involves cutting a small, long opening in the occipital area behind the ear, either horizontally or vertically. The horizontal incision is generally preferred because it is a little smaller, usually 4 cm; the vertical incision is a little longer because it involves more of the surrounding muscles. The advantage of the incision behind the ear is that the hair will cover the incision site after surgery, so you generally can’t see the scar, so you don’t have to worry about breaking your face ~~ (see below) ③ Remove a dollar coin-sized bone flap: cut the skin behind the ear, separate the muscle or blood vessels and other tissues, expose the occipital bone at the brain shell, and then use a special surgical instrument – grinding drill. A few small incisions are drilled in the occipital bone, and then a small piece of the occipital bone here is cut off with a scalpel – roughly the size of a dollar coin – and the small piece of bone flap here is uncovered, allowing access to the facial nerve and the surrounding blood vessels involved. (See below.) ④Finding the facial nerve and the blood vessels involved: Since there are many nerves and blood vessels in the cranial brain, finding the facial nerve and the blood vessels involved depends not only on a special preoperative MRI, but also on the surgeon’s surgical experience and skill. There are 12 pairs of nerves running through the brain, symmetrically distributed, and each pair of nerves has its own special way of travel. Under the microscope, the surgeon has to carefully find the facial nerve. Since the nerves are flexible, if they are simply picked up with surgical instruments, when the instruments are removed, the facial nerve will spring back to its original position and the patient’s facial spasm symptoms will remain unrelieved, so it is easy to relapse. Therefore, it is necessary to use special shock-absorbing materials to separate the two. By separating them, the pulsation of the blood vessels will not directly stimulate the facial nerve, thus achieving a cure for the facial muscle spasm. (See below.) ⑤ Special spacer to separate the blood vessel and nerve: The facial nerve and the blood vessel in question are found in the skull and a special material, Teflon spacer (sponge pad), is used to separate the blood vessel from the nerve. The sponge pad has a shock-absorbing and cushioning effect that minimizes the irritation of the facial nerve by the pulsating blood vessels. Moreover, the spacer is not easily absorbed or displaced, and it can work all the time after implantation to effectively prevent recurrence. It is like two people arguing and the spacer acts as a puller. The spacers are usually placed 1-3 times, and since the sponge pad itself is very soft, there is no need to worry about pressing on the blood vessels or nerves. (See below) (6) Intraoperative electrophysiological detector instantly detects the effect: Compared with other hospitals, the advantage of Xuanwu Hospital’s functional neurosurgery for facial muscle spasm also lies in the fact that there is an important set of intraoperative monitoring equipment, the neuroelectrophysiological detector, which can reflect more directly and instantly whether the surgery is effective or not during the surgery. During surgery, the detector is connected to the patient’s eyes, cheeks and other twitching areas. If the detector shows an abnormal electrophysiological waveform, it means that the perpetrator vessel is stimulating the facial nerve. When the surgeon separates the facial nerve from the offending vessel, the abnormal waveform on the detector disappears; if the surgeon places the shim in the wrong place or not accurately enough, then the abnormal waveform will not disappear. Therefore, whether the spacer has worked or not can be found during the surgery, and there is no need to wait until the patient wakes up to judge the effect of the surgery. (7) Resetting the bone flap: The separated bone flap is put back to its original position and a bone clip is used to connect the flap to the occipital bone to ensure the complete cranial structure, and the bone clip needs to be fixed here all the time to ensure the integrity of the skull. （The incision is closed with sutures (see below). The procedure usually takes 45 minutes to 2 hours. These 7 steps are simple to say, but in practice, they test the surgeon’s surgical skills, adequate preoperative preparation, and precise intraoperative monitoring. Doing these three things can minimize trauma and improve the healing rate. This article is an original work and may not be reproduced without authorization.