Wand O, Grossman A, Assa A, Tal D, Shupak A. Medical waiver for flying after microvascular decompression for hemifacial spasm. Aviat Space Environ Med 2011; 82:137–9. Background: Microvascular decompression has become the treatment of choice for hemifacial spasm. Post-surgical symptoms of vestibular dysfunction may appear, but are mostly transient. The unique occupational demands of military aviators necessitate complete otoneurological evaluation after vestibular insults to allow safe return to flying duties. Case Report: We present a case of a military jet-fighter pilot who developed transient vertigo and disequilibrium after microvascular decompression for hemifacial spasm. Resolution of symptoms and complete recovery as documented by vestibular bedside and laboratory tests allowed us to grant the pilot full solo flying privileges.