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Five years ago, Dr. Richard Van Allen was playing golf on a sunny afternoon in southern California when he felt a twitch in his eye. A bug or dirt most likely was the cause, he thought. But, he found nothing after a quick check with his finger. The twitch stopped and Richard kept on playing the sport he loved.
Five weeks later, the twitch returned. This time it was more noticeable, and both he and his wife were becoming concerned.
“I was looking in the mirror and could see my eye moving... I thought maybe I was just seeing things but then my wife saw that it was moving too. We just hoped it was a sign of aging, but I felt in the back of my mind that something wasn’t right.”
As time went on, Richard’s eye twitch would come and go. Some times were more bothersome than others.
“I would be talking to my patients and my eye would start to spasm... I knew they could see it and it started to become a distraction.”
Richard began doing research online on what could possibly be causing his eye twitch. He came across hemifacial spasm, a disease characterized by frequent involuntary twitching of one side of the face usually caused by a blood vessel pressing on the facial nerve at the point where the nerve exits the brainstem.
“The symptoms of hemifacial spasm were exactly what I was experiencing... It definitely freaked me out.”
A concerned Richard then made an appointment with a neurologist, who confirmed the diagnosis of hemifacial spasm. Because Richard’s symptoms we not interfering with his sight, and were not constant, no surgical treatment was recommended.
A year and a half later, Richard continued to live his life as normally as he could, but his symptoms were getting worse.
“I was squinting when I was seeing my patients, and I used to tell them I was focusing on something... But, it was just me trying to cover up the disease.”
Richard began doing some additional research, this time for surgeons who were well known for treating hemifacial spasm. His search brought him to Dr. Raymond Sekula of UPMC.
“From my research, I found that Dr. Sekula had among the highest success rates for treating hemifacial spasm... So, I picked up the phone and gave him a call.”
They spoke at length about Richard’s condition and possible treatment options, which included microvascular decompression surgery (MVD) – a minimally invasive surgical procedure that treats the cause of hemifacial spasm.
“He was very informative and sent me articles, videos, and a lot of other helpful materials about treating hemifacial spasm using MVD... He said that I would eventually need surgery, but because my symptoms were manageable, it could wait a while.”
During the next two years, while the two kept in touch, Richard’s symptoms were becoming more and more unbearable.
“I saw that my personality was changing and I was not the same outgoing person I had been... So after talking more with Dr. Sekula about my options, and even hearing from some of his former patients and their success, I decided to proceed with the surgery.”
After Richard and Dr. Sekula scheduled a date for the procedure, Richard packed his bags for the cross-country trip.
“It’s crazy to get on a plane and travel 2,500 miles for surgery... But I knew that Dr. Sekula was one of the best in the world at treating hemifacial spasm, so I was confident that I made the right decision.”
During the surgery, Dr. Sekula accessed Richard’s cranial nerves through a small opening behind the ear about the size of a silver dollar.
Under the view of a microscope, Dr. Sekula detected the area where the blood vessel was affecting the nerve and then separated them, leaving a nonstick PTFE (polytetrafluoroethylene) "pillow" in between.
Because recovery from MVD is brief, Richard was able to return to his hotel room the following day. He flew home to Los Angeles a few days later.
Three weeks following surgery, the now 50-year-old doctor had a recurrence of spasms, but a quick call from his doctor in Pittsburgh put him back at ease.
“I started having spasms again and it really concerned me... But after a call with Dr. Sekula, he assured me that the procedure is effective and that over time my spasms would be nearly gone, if not completely eliminated.”
“He was right,” Richard says. As more time passed following surgery, Richard’s spasms continued to decline, and around the 18-month mark, they all but vanished.
“I would say that 95 percent of the spams are now gone and I rarely experience any symptoms,” he says. “I’m back to being my fun and outgoing self and I’m seeing patients without any difficulty. I definitely made a good decision to travel to Pittsburgh.”
Our patient stories profile a number of patients who have had minimally invasive brain surgery at UPMC. Although everyone's care experience is unique, we hope that sharing these stories will help other prospective patients and their families better understand these procedures and their potential benefits.
Richard's treatment and results may not be representative of all similar cases.
Dr. Raymond Sekula discusses treatment options for hemifacial spasm.