J Korean Neurosurg Soc.  2012 Oct;52(4):372-376. 10.3340/jkns.2012.52.4.372.

Efficacy of the Disappearance of Lateral Spread Response before and after Microvascular Decompression for Predicting the Long-Term Results of Hemifacial Spasm Over Two Years

• Kang MC
• Choi YS
• Choi HK
• Lee SH
• Ghang CG
• Kim CH

• KMID: 2190655
• DOI: http://doi.org/10.3340/jkns.2012.52.4.372

Abstract

OBJECTIVE
The purpose of this large prospective study is to assess the association between the disappearance of the lateral spread response (LSR) before and after microvascular decompression (MVD) and clinical long term results over two years following hemifacial spasm (HFS) treatment.
METHODS
Continuous intra-operative monitoring during MVD was performed in 244 consecutive patients with HFS. Patients with persistent LSR after decompression (n=22, 9.0%), without LSR from the start of the surgery (n=4, 1.7%), and with re-operation (n=15, 6.1%) and follow-up loss (n=4, 1.7%) were excluded. For the statistical analysis, patients were categorized into two groups according to the disappearance of their LSR before or after MVD.
RESULTS
Intra-operatively, the LSR was checked during facial electromyogram monitoring in 199 (81.5%) of the 244 patients. The mean follow-up duration was 40.9+/-6.9 months (range 25-51 months) in all the patients. Among them, the LSR disappeared after the decompression (Group A) in 128 (64.3%) patients; but in the remaining 71 (35.6%) patients, the LSR disappeared before the decompression (Group B). In the post-operative follow-up visits over more than one year, there were significant differences between the clinical outcomes of the two groups (p<0.05).
CONCLUSION
It was observed that the long-term clinical outcomes of the intra-operative LSR disappearance before and after MVD were correlated. Thus, this factor may be considered a prognostic factor of HFS after MVD.

Keyword

Clinical outcome; Hemifacial spasm; Lateral spread response; Microvascular decompression

MeSH Terms

Decompression
Follow-Up Studies
Hemifacial Spasm
Humans
Microvascular Decompression Surgery
Prospective Studies

Figure

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  Fig. 1 Mean value of the improved percentage of the spasm compared to the initial symptom according to the follow-up duration. This graph shows remarkable differences in these values between Groups A and B, since the post-operative one-year follow-up.

Reference

1. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Shields PT, Larkins MV, Jho HD. Microvascular decompression for hemifacial spasm. J Neurosurg. 1995; 82:201–210. PMID: 7815147.

2. Haines SJ, Torres F. Intraoperative monitoring of the facial nerve during decompressive surgery for hemifacial spasm. J Neurosurg. 1991; 74:254–257. PMID: 1988595.

3. Hatem J, Sindou M, Vial C. Intraoperative monitoring of facial EMG responses during microvascular decompression for hemifacial spasm. Prognostic value for long-term outcome : a study in a 33-patient series. Br J Neurosurg. 2001; 15:496–499. PMID: 11814001.

4. Ishikawa M, Ohira T, Namiki J, Gotoh K, Takase M, Toya S. Electrophysiological investigation of hemifacial spasm : F-waves of the facial muscles. Acta Neurochir (Wien). 1996; 138:24–32. PMID: 8686521.

5. Ishikawa M, Ohira T, Namiki J, Kobayashi M, Takase M, Kawase T, et al. Electrophysiological investigation of hemifacial spasm after microvascular decompression : F waves of the facial muscles, blink reflexes, and abnormal muscle responses. J Neurosurg. 1997; 86:654–661. PMID: 9120630.

6. Isu T, Kamada K, Mabuchi S, Kitaoka A, Ito T, Koiwa M, et al. Intra-operative monitoring by facial electromyographic responses during microvascular decompressive surgery for hemifacial spasm. Acta Neurochir (Wien). 1996; 138:19–23. discussion 23. PMID: 8686520.

7. Joo WI, Lee KJ, Park HK, Chough CK, Rha HK. Prognostic value of intra-operative lateral spread response monitoring during microvascular decompression in patients with hemifacial spasm. J Clin Neurosci. 2008; 15:1335–1339. PMID: 18617405.

8. Kim CH, Kong DS, Lee JA, Kwan-Park . The potential value of the disappearance of the lateral spread response during microvascular decompression for predicting the clinical outcome of hemifacial spasms : a prospective study. Neurosurgery. 2010; 67:1581–1587. discussion 1587-1588. PMID: 21107188.

9. Kiya N, Bannur U, Yamauchi A, Yoshida K, Kato Y, Kanno T. Monitoring of facial evoked EMG for hemifacial spasm : a critical analysis of its prognostic value. Acta Neurochir (Wien). 2001; 143:365–368. PMID: 11437290.

10. Kong DS, Park K, Shin BG, Lee JA, Eum DO. Prognostic value of the lateral spread response for intraoperative electromyography monitoring of the facial musculature during microvascular decompression for hemifacial spasm. J Neurosurg. 2007; 106:384–387. PMID: 17367059.

11. McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK. Microvascular decompression of cranial nerves : lessons learned after 4400 operations. J Neurosurg. 1999; 90:1–8. PMID: 10413149.

12. Møller AR, Jannetta PJ. Hemifacial spasm : results of electrophysiologic recording during microvascular decompression operations. Neurology. 1985; 35:969–974. PMID: 4010963.

13. Møller AR, Jannetta PJ. Microvascular decompression in hemifacial spasm : intraoperative electrophysiological observations. Neurosurgery. 1985; 16:612–618. PMID: 4000433.

14. Møller AR, Jannetta PJ. Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm. J Neurosurg. 1987; 66:681–685. PMID: 3572493.

15. Mooij JJ, Mustafa MK, van Weerden TW. Hemifacial spasm : intraoperative electromyographic monitoring as a guide for microvascular decompression. Neurosurgery. 2001; 49:1365–1370. discussion 1370-1371. PMID: 11846935.

16. Park JS, Kong DS, Lee JA, Park K. Hemifacial spasm : neurovascular compressive patterns and surgical significance. Acta Neurochir (Wien). 2008; 150:235–241. discussion 241. PMID: 18297233.

17. Shin JC, Chung UH, Kim YC, Park CI. Prospective study of microvascular decompression in hemifacial spasm. Neurosurgery. 1997; 40:730–734. discussion 734-735. PMID: 9092846.

18. Sindou MP. Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring. Acta Neurochir (Wien). 2005; 147:1019–1026. discussion 1026. PMID: 16094508.

19. Yamashita S, Kawaguchi T, Fukuda M, Watanabe M, Tanaka R, Kameyama S. Abnormal muscle response monitoring during microvascular decompression for hemifacial spasm. Acta Neurochir (Wien). 2005; 147:933–937. discussion 937-938. PMID: 16010450.