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Published online by Cambridge University Press: 10 July 2025
Background: Hemifacial spasm (HFS) is a disorder of unilateral facial myoclonus that can be psychosocially debilitating. It is generally caused by microvascular compression of the facial nerve and is amenable to potentially curative surgery. Unfortunately, many patients receive delayed surgical referrals and are instead managed with injections of botulinum toxin to varying benefit. The reason behind late referrals is unclear, but one factor may be misleading diagnostic information; specifically, MRI reports that indicate incorrect or absent neurovascular conflict. The goal of this study was to explore the association between MRI reports and operative findings in HFS patients, with the hopes of identifying opportunities for improved diagnosis and treatment. Methods: We performed a single-center, retrospective chart review of 30 consecutive patients who underwent surgery for HFS between January 2019 and January 2020. Descriptive data were extracted from pre-operative MRI reports and operative notes, then coded for statistical analysis. Results: Pre-operative MRIs were reported by radiologists from 6 provinces. Across all MRIs (n = 45), a positive finding was only identified in 51.1%. All 30 patients had clear neurovascular conflict noted in surgery. Conclusions: There is a need for improved diagnostic accuracy in HFS, with the goal of expediting surgical referrals and possible cure.