For Jason Pavlich, the facial spasms started in 2020 with a tingle on the left side of his head. Then, it developed into an occasional twitch in his left eye. By the time he saw a local neurologist about a month later, he was experiencing intermittent muscle spasms around his eye.
“It just kept getting progressively worse,” says Jason, 45, of Red Hook, located in the center of the Hudson Valley in upstate New York.
The Challenge
Jason was diagnosed with hemifacial spasm, a disorder of the nerves and muscles that causes involuntary twitching on one side of the face. It is a condition usually caused by a small blood vessel pressing on a facial nerve. An MRI later confirmed the diagnosis. But in Jason’s case, the culprit was a large vertebral artery.
Over the next two years, Jason followed various nonsurgical treatments suggested by his doctor. In addition to eliminating alcohol and caffeine, he took anticonvulsants and Parkinson’s disease medicine. He eventually tried BOTOX® injections*. But Jason’s spasms continued to worsen, becoming more frequent and eventually involving the full left side of his face. His symptoms progressed so much they interfered with daily activities such as reading and driving.
“None of the treatments had any lasting impact and my symptoms kept progressing,” says Jason. “I became very self-conscious.
“But there was no hiding from it. I’m constantly interacting with people,” adds Jason, who teaches advanced chemistry at Red Hook High School and coaches the school’s varsity girls soccer team.
“I was very upfront about it with the kids. I told them there’s something wrong with my face, it’s a neurological issue, I’m seeking medical help, and I’m trying to get it fixed.”
The Path to UPMC
After exhausting nonsurgical treatments, Jason’s neurologist recommended he see a specialist. Jason reached out to a prominent academic hospital in New York City where a neurosurgeon recommended relieving pressure on the nerve through a microvascular decompression (MVD) procedure. However, because it involved a larger vertebral artery, Jason was told that he would have to spend several days in the hospital, including two days in the intensive care unit, and would likely need a spinal drain. He was also told that there was a high chance of hearing loss.
“I visited the hospital and was all set to have the surgery there,” says Jason. “But this was brain surgery, so I decided — with the neurosurgeon’s blessing — to get a second opinion.”
Based on recommendations from multiple other doctors, Jason contacted the Neurosurgery Department at UPMC Presbyterian in August 2023. He was referred to Georgios A. Zenonos, MD, a UPMC neurosurgeon and specialist in skull base surgery. Dr. Zenonos directs the UPMC Cranial Nerve Disorders Program and is co-director of the UPMC Center for Cranial Base Surgery.
After talking together by phone, Jason arranged an in-person visit to meet with Dr. Zenonos. Dr. Zenonos also recommended MVD surgery — the only known permanent treatment for hemifacial spasm. However, because of the size of the artery, he also recommended inserting a small sling to pull the vessel away from the nerve.
Jason and his wife also toured UPMC Presbyterian and visited Family House, a nearby nonprofit residence where patients and family members can stay when traveling to Pittsburgh for medical care.
“I liked Dr. Zenonos very much. The fact that he specializes in skull base surgery was important,” says Jason. “But what made me choose UPMC was the feel of the hospital. Everything felt calm and quiet. Having access to Family House was a big factor, too. Everything just added up.”
The Solution
In October 2023, Jason underwent minimally invasive MVD surgery at UPMC Presbyterian. During the procedure, Dr. Zenonos made a 1.5-inch incision behind his ear. He then performed a performed a craniotomy, making a small hole in his skull to access the artery.
To relieve pressure on the nerve, Dr. Zenonos used the sling technique to pull the artery away. He also inserted a sponge-like material to keep the nerve and artery separated.
Jason spent two nights in the hospital — on a regular floor in a private room — following surgery, staying one more night than originally planned to be sure there were no issues. No ICU or spinal drains were necessary.
The Results
As the swelling subsided following surgery, Jason noticed his spasms were becoming less frequent and intense. Within a few days, they had stopped completely.
“It was great. For the first time in two years, I had no spasms,” says Jason.
After a follow-up appointment with Dr. Zenonos at the end of the week, Jason was cleared to make the seven-hour drive — with his wife at the wheel — back home to Red Hook. He has since made a full recovery, experienced no hearing loss, and returned to the classroom four weeks after his surgery.
“There are days when I forget I ever had surgery,” says Jason. “And I haven’t had a single spasm. It’s nice not to be self-conscious every time I talk to someone.
“I’m very grateful for the excellent care I received at UPMC,” he adds. “It was definitely worth the drive.”
*BOTOX® is a trademark of Allergan, Inc.