INTRODUCTION: Hemifacial spasm (HFS) causes unilateral intermittent and involuntary contractions of facial muscles attributable to compression at the root exit zone of the facial nerve. Microvascular decompression (MVD) is the most effective treatment option for patients with primary HFS. However, the time needed for initial complete resolution of the symptoms varies between patients undergoing the MVD. METHODS: We performed a retrospective review of our prospectively maintained database including all HFS patients who underwent de-novo MVD with a minimum follow-up of six months. We excluded patients with a non-arterial etiology of compression. We assessed postoperative outcome clinically based on patient reported symptom severity as a percentage of preoperative symptoms severity. We performed survival analysis and Cox regression to identify the factors significantly affecting the time needed to initial resolution of the symptoms. Statistical analysis was performed using R software version 3.6.3. RESULTS: 349 patients were included. The mean (SD) follow-up was 55 (36) months. 308 patients (88.3%) demonstrated initial postoperative recovery which occurred in 50% of the cases at a median of 5 days (95%CI 5-7) after surgery, however 93 of whom reported some recurrent symptoms during their postoperative course. AICA, AICA VA compression, or development of postoperative facial palsy independently showed a statistically significant lower hazard of no initial resolution of symptoms compared to other compression etiologies, and evident peripheral indentation of the facial nerve in contrast showed an increased hazard of no initial resolution of symptoms compared to brainstem or no indentation. CONCLUSION: AICA compressions, and development of postoperative facial palsy predict a more favorable outcome. Compared to central brain stem indentation of the facial nerve, peripheral indentation is associated with longer time to initial resolution of symptoms.