Hemifacial spasm (HFS) is a rare condition characterized by unilateral facial muscle contractions. While the condition is painless and nonfatal, it can have a significant impact on quality of life and result in social stigmatization [1]. The etiology of the condition is now more clearly understood to be from neurovascular compression (NVC) of the ipsilateral facial nerve and fortunately can be treated safely, effectively, and durably through microvascular decompression (MVD) surgery [2]. In fact, several published series have reported long-term spasm relief in up to 90% of cases with low morbidity or mortality rates [3–6]. Despite this, much of the medical community considers serial botulinum toxin injections (SBIs) to be the treatment of choice [7]. As a result, there remains very low utilization rates of MVD for HFS resulting in few neurosurgeons being able to establish a high-volume practice [8]. With limited experience, failure and complication rates of MVD for HFS may be unnecessarily high. This can result in referral patterns that favor SBIs and further limit surgical experience.