Abstract: Facial spasm is caused by abnormal excitability of nerves due to microvessel compression in the facial nerve root exit zone with paroxysmal convulsion as the main symptom. Microvascular decompression is a common method for the treatment of hemifacial spasm, which helps to eliminate local vascular compression and restore facial nerve function. The key of microvascular decompression is to identify the responsible blood vessels, separate the responsible blood vessels from the nerve root and relieve the compression. Neuroelectrophysiological monitoring can identify the responsible blood vessels, record EMG activity to determine facial nerve outcome after decompression, which improves efficacy of microvascular decompression for the treatment of hemifacial spasm. In this review, the role of neurophysiological monitoring methods including abnormal muscle response (AMR), electromyogram (EMG), abnormal muscle response (AMR) and ZL response (ZLR response) in microvascular decompression for the treatment of hemifacial spasm and the postoperative complications are described.