Hemifacial Spasm: Intraoperative Electromyographic Monitoring as a Guide for Microvascular Decompression

Neurosurgery ◽  
2001 ◽  
Vol 49 (6) ◽  
pp. 1365-1371 ◽  
Author(s):  
Jan Jakob A. Mooij ◽  
Mustafa K. Mustafa ◽  
Tom W. van Weerden
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Intraoperative Monitoring ◽  
Cure Rate ◽  
Muscle Response ◽  
Nerve Monitoring ◽  
Abnormal Muscle Response ◽  
Facial Nerve Monitoring

ABSTRACT OBJECTIVE Microvascular decompression is the logical and well-accepted treatment of choice for hemifacial spasm (HFS). In experienced hands, good to excellent results can be obtained. However, sometimes the exact site of the vascular compression is unclear. The aim of this study was to analyze whether intraoperative monitoring by stimulated electromyography of the facial nerve may help to improve the results of vascular decompression for HFS. METHODS In a series of 74 patients operated for HFS, the impact of intraoperative facial nerve monitoring on the surgical procedure was analyzed by use of the clinical and operative patient records. The role of this type of monitoring, with assessment of the so-called abnormal muscle response, was broken down into four categories: a guiding, a confirming, an indirect confirming, or an inconclusive role. The relationship between abnormal muscle response monitoring results and final surgical outcome was analyzed. RESULTS The overall cure rate was 87.8%, including patients who had previously undergone unsuccessful operations. Complications were minor, and hearing impairment was found in 2.7% of patients. A guiding role of intraoperative monitoring was apparent in 33.8% of patients, and a confirming role was demonstrated in 52.7% of patients, which resulted in a positive contribution of approximately 87% for intraoperative facial monitoring in microvascular decompression for HFS. In patients defined as guiding cases, the cure rate was 92%. CONCLUSION This study demonstrates the applicability and usefulness of intraoperative facial nerve monitoring in microvascular decompression operations for HFS.

Additional Benefits of Facial Nerve Monitoring during Otologic Surgery

2020 ◽  
Vol 163 (3) ◽  
pp. 572-576
Author(s):  
Kelsey Casano ◽  
Gerard Giangrosso ◽  
Gauri Mankekar ◽  
Alexander Sevy ◽  
Rahul Mehta ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Structured Interviews ◽  
Nerve Monitoring ◽  
Tertiary Referral Center ◽  
Otologic Surgery ◽  
Increased Risk ◽  
Facial Nerve Monitoring ◽  
Adults And Children ◽  
Facial Nerve Stimulation

Objective This study assesses the role of facial nerve monitoring (FNM) for intraoperative decision making during otologic surgery and possible benefits beyond protecting facial nerve integrity. Study Design This prospective study examines intraoperative FNM data and structured interviews collected during 52 otologic procedures. Setting Tertiary referral center. Subjects and Methods Subjects include adults and children undergoing middle ear or mastoid surgery. Data include intraoperative neuromonitoring activity and structured interviews conducted with the operating surgeon immediately following surgery. Results Facial nerve stimulation was used to confirm the position of the nerve in 42 of 52 surgical procedures. In 26.9% of cases, the patient became “light” and moved under anesthesia, which was predicted by neuromonitoring 71.4% of the time. Through structured interviews, the operating surgeons reported the following. (1) The facial nerve took an unexpected anatomic course in 7.8% of patients and was difficult to identify in 39.2%. (2) The nerve was at increased risk of injury in 66.7% of cases due to chronic disease or previous surgery. (3) Among these high-risk cases, the monitor helped reduce the risk of nerve damage 100% of the time. (4) Neuromonitoring allowed the surgeon to operate faster 86.5% of the time, and (5) FNM allowed the resident to perform more of the operation 68.9% of the time. No patients experienced postoperative facial weakness. Conclusions Beyond potentially protecting facial nerve integrity, this study identified additional benefits of FNM, including warning of patient movement during anesthesia, confirming facial nerve anatomic location, reducing operative time, and enhancing resident surgical experience.

The Effects of Combined Intraoperative Monitoring of Abnormal Muscle Response and Z-L Response for Hemifacial Spasm

2017 ◽  
Vol 108 ◽  
pp. 367-373 ◽  
Author(s):  
Xin Zhang ◽  
Hua Zhao ◽  
Yin-Da Tang ◽  
Jin Zhu ◽  
Ping Zhou ◽  
...  
Keyword(s):  
Hemifacial Spasm ◽  
Intraoperative Monitoring ◽  
Muscle Response ◽  
Abnormal Muscle Response

Intraoperative monitoring of the facial nerve during decompressive surgery for hemifacial spasm

1991 ◽  
Vol 74 (2) ◽  
pp. 254-257 ◽  
Author(s):  
Stephen J. Haines ◽  
Fernando Torres
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Intraoperative Monitoring ◽  
Circumstantial Evidence ◽  
Etiological Factor ◽  
Content Type ◽  
Abnormal Response ◽  
Facial Nerve Decompression ◽  
Fine Print

✓ In 11 consecutive patients, intraoperative electromyographic (EMG) recordings were made from the facial muscles during microvascular decompression for hemifacial spasm. In one patient, recordings could not be obtained for technical reasons, and two patients had no abnormality. In the remaining eight patients, the abnormal response resolved before decompression in two, resolved immediately at the time of decompression in five, and failed to resolve in one. All patients were relieved of their hemifacial spasm. In the five patients whose abnormalities resolved at the time of decompression, there was a precise intraoperative correlation between decompression of the nerve and disappearance of the abnormal EMG response. In three cases, this was a useful guide to the need to decompress more than one vessel. These results confirm the findings of Mailer and Jannetta, support the use of this technique for intraoperative monitoring of facial nerve decompression procedures, and provide strong circumstantial evidence that vascular cross-compression is an important etiological factor in hemifacial spasm.

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