Although Botox can treat facial muscle spasms, after all, it can still recur and is not a long-term solution. So, is there a complete cure for facial muscle spasm? In fact, there is a once and for all solution. Since the facial muscle spasm is due to the blood vessels pressing on the facial nerve, it is good to set aside the blood vessels and isolate them from the nerve with special materials, which is called microvascular decompression surgery. So when is surgery appropriate? Generally, surgery is needed after 1 year of onset. Zhu Hongwei, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, has a history of less than 1 year of mild symptoms, which can be easily confused with eyelid spasm, habitual tics, etc. Therefore, waiting until a year later can confirm whether it is facial myoclonus and avoid misdiagnosis and mistreatment (for more details, please see the article series “Long-term eyelid fluttering or facial myoclonus”). In addition, surgery 1 year after the onset of the disease will not affect other functions of the patient and will not affect the outcome of the surgery due to disease progression. For patients who need surgery, preoperative blood tests, four coagulation tests, blood glucose and special MRI are performed. The first three tests are mainly to assess whether the patient is suitable for surgery. Among them, the routine blood and coagulation tetralogy are mainly to check the patient’s coagulation function to avoid bleeding more than once after the operation. If the platelets are too low, it is not suitable for immediate surgery. The main purpose of checking blood sugar is to avoid high blood sugar affecting the healing of the wound and subsequent infection. These tests can be done first in the outpatient clinic, but the cost of outpatient tests may not be reimbursed, so it is advisable to do the pre-operative tests after hospitalization. The special nuclear magnetic examination – 3D-TOF-MRA can clearly show the relationship between the facial nerve and the culprit vessel, and guide the surgeon to identify the facial nerve and the culprit vessel from the dense intracranial nerves and vessels, so as to avoid missing or “hurting the innocent” during the surgery to the maximum extent possible. This minimizes the possibility of missing or “hurting” the patient during surgery. With normal MRI, either only the imaging of blood vessels or only the imaging of nerves can be seen. However, facial spasm requires the doctor to clearly identify the relationship between the blood vessels and nerves, so this special MRI is very important and necessary. This test can be performed at a general tertiary care hospital. Usually, when the patient shows the special MRI film and report to the doctor during the outpatient visit, the doctor will tell the patient which blood vessel needs to be cushioned, instead of waiting until the surgery to slowly identify the blood vessel in question, so that the patient can be prepared. At the same time, the doctor will be able to have a good idea of what to expect, and the damage to the intracranial nerves and blood vessels during surgery will be smaller, further reducing the possibility of postoperative complications. Because of the preoperative preparation, 70% of patients’ symptoms disappear immediately after surgery; 23% of patients take several months to a year to disappear. Patients with facial spasm who have had the disease for 8 years or less can achieve a 93% cure rate after surgery; however, patients who have had the disease for longer than 8 years have a lower cure rate. Because of the long-term compression of the facial nerve, some edema and demyelination (similar to the short circuit of a wire shedding) will occur, resulting in a decrease of the cure rate to 83%. In conclusion, for most people, this surgical method can still cure facial muscle spasm radically. This article is an original work and may not be reproduced without authorization.