Aim:Primary hemifacial spasm (HFS) is caused by vascular compression of the facial nerve root entry zone. Microvascular decompression (MVD) is an effective method in patients who are resistant to conservative strategies. Here we aimed to determine the efficacy and safety of MVD for HFS by retrospectively reviewing our results.Material and Methods:A total of 55 patients who underwent MVD in our clinic between 2003 and 2017 were retrospectively analyzed. Clinical outcome results, recurrence rates, and surgical complications were noted.Results:Thirty-six patients were female (65%). The mean age of the patients was 51.3 years. The mean duration of the complaint was 46.4 months. In 45 patients (82%), HFS was completely resolved within the first 6 months after the surgery. Five patients (9%) with recurrent symptoms were reoperated within the first year of the surgery. HFS symptoms of five patients (9%) completely ceased initially, but started again and reoperation was required due to failure of alternative treatments. Delayed facial nerve palsy and hearing loss were noted in one patient for each (2%). Cerebrospinal fluid leak was observed in two patients (4%). No mortality was observed in this series.Conclusion:MVD is a safe and effective option for patients with HFS that is resistant to medical treatment.