This soundless video of surgery for hemifacial spasm shows retrosigmoid exposure and microvascular decompression of the ectatic basilar artery with stepwise mobilization and packing. The patient is a 61-year-old woman who had experienced progressive left hemifacial spasm and left facial weakness for several years. After surgery the patient reported complete remission of hemifacial spasm and return of her facial strength. For additional reading, click here. Contributed by Richard W. Byrne, MD, Chicago, Ill.