The novel prognostic value of postoperative follow-up lateral spread response after microvascular decompression for hemifacial spasm

OBJECTIVE The lateral spread response (LSR) is an aberrant electrophysiological response in which a stimulus on one branch of the facial nerve spills over to other branches of the nerve, which can be captured by electrodes near each branch. The authors performed this study to evaluate the prognostic value of the follow-up LSR with a sufficient time interval from intraoperative LSR (IO-LSR) after microvascular decompression (MVD) for hemifacial spasm (HFS), excluding the interference of various intraoperative situations. METHODS A total of 247 patients treated with MVD for HFS between June 2011 and March 2019 were enrolled in this study. The IO-LSR was routinely evaluated in all patients. The LSR was checked again on postoperative day (POD) 2 after surgery (POD2-LSR). A total of 228 patients (92.3%) were considered cured at the last clinical follow-up. RESULTS The IO-LSR disappeared in 189 patients (76.5%), and among them, 181 patients (95.8%) were cured 1 year after surgery. The POD2-LSR disappeared in 193 patients (78.1%), and 185 patients (95.9%) among them were cured. Among the 189 patients in which the IO-LSR disappeared, the POD2-LSR reappeared in 26 patients (13.8%). In contrast, the POD2-LSR disappeared in 30 (51.7%) of 58 patients for whom the IO-LSR continued at the end of surgery. When classified into groups according to the status of the IO-LSR and POD2-LSR, in the group of patients in whom both LSRs disappeared, the cure rate was 98.2%, which was significantly higher than that of the other 3 groups (p < 0.05, Cochran-Armitage trend test). The use of both LSRs was found to be significantly associated with better predictability (p < 0.05, McNemar’s test). CONCLUSIONS Postoperative follow-up LSR examination may be beneficial in predicting clinical outcomes after MVD for HFS, especially when considered together with IO-LSR.

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Prognostic ability of intraoperative electromyographic monitoring during microvascular decompression for hemifacial spasm to predict lateral spread response outcome

Journal of Neurosurgery ◽

10.3171/2016.1.jns151782 ◽

2017 ◽

Vol 126 (2) ◽

pp. 391-396 ◽

Cited By ~ 9

Author(s):

Sung Ho Lee ◽

Bong Jin Park ◽

Hee Sup Shin ◽

Chang Kyu Park ◽

Bong Arm Rhee ◽

...

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Prognostic Value ◽

University Hospital ◽

Lateral Spread ◽

Symptom Duration ◽

Group A ◽

Lateral Spread Response ◽

Group B

OBJECTIVE Abnormal lateral spread response (LSR) is a typical finding in facial electromyography (EMG) in patients with hemifacial spasm (HFS). Although intraoperative monitoring of LSR has been widely used during microvascular decompression (MVD), the prognostic value of this monitoring is still debated. The purpose of this study was to determine whether such monitoring exhibits prognostic value for the alleviation of LSR after treatment of HFS. METHODS Between January 2009 and December 2013, a total of 582 patients underwent MVD for HFS with intraoperative EMG monitoring at Kyung Hee University Hospital. The patients were categorized into 1 of 2 groups according to the presence of LSR at the conclusion of surgery (Group A, LSR free; Group B, LSR persisting). Patients were assessed for the presence of HFS 1 day, 6 months, and 1 year after surgery. Various parameters, including age, sex, symptom duration, offending vertebral artery, and offending perforating artery, were evaluated for their influence on surgical and electrophysiological results. RESULTS Overall, HFS was alleviated in 455 (78.2%) patients 1 day after MVD, in 509 (87.5%) patients 6 months after MVD, and in 546 (93.8%) patients 1 year after MVD. Patients in Group B were significantly younger than those in Group A (p = 0.022). Patients with a symptom duration of less than 1 year were significantly more likely to be classified in Group A than were patients whose symptoms had persisted for longer than 10 years (p = 0.023); however, analysis of the entire range of symptom durations did not reveal a significant effect (p = 0.132). A comparison of Groups A and B according to follow-up period revealed that HFS recovery correlated with LSR alleviation over a shorter period, but the same was not true of longer periods; the proportions of spasm-free patients were 80.6% and 71.1% (p = 0.021), 89.4% and 81.9% (p = 0.022), and 93.5% and 94.6% (p = 0.699) 1 day, 6 months, and 1 year after surgery in Groups A and B, respectively. CONCLUSIONS Although intraoperative EMG monitoring during MVD was beneficial for identifying the offending vessel and suggesting the most appropriate surgical end point, loss of LSR did not always correlate with long-term HFS treatment outcome. Because the HFS cure rate improved over time, revision might be considered for persistent LSR when follow-up has been performed for more than 1 year and the spasm remains despite adequate decompression.

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Prognostic value of intra-operative lateral spread response monitoring during microvascular decompression in patients with hemifacial spasm

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2007.08.008 ◽

2008 ◽

Vol 15 (12) ◽

pp. 1335-1339 ◽

Cited By ~ 45

Author(s):

Won-Il Joo ◽

Kyung-Jin Lee ◽

Hae-Kwan Park ◽

Chung-Kee Chough ◽

Hyoung-Kyun Rha

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Prognostic Value ◽

Lateral Spread ◽

Response Monitoring ◽

Lateral Spread Response

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Prognostic value of lateral spread response during microvascular decompression for hemifacial spasm

Journal of International Medical Research ◽

10.1177/0300060519839526 ◽

2019 ◽

Vol 47 (12) ◽

pp. 6120-6128

Author(s):

Hongmei Song ◽

Songbai Xu ◽

Xiushuang Fan ◽

Mingxin Yu ◽

Jiachun Feng ◽

...

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Surgical Outcomes ◽

Prognostic Value ◽

Prognostic Indicator ◽

Lateral Spread ◽

Short Term ◽

Group A ◽

Lateral Spread Response

Objective This study aimed to investigate the prognostic value of the lateral spread response (LSR) for predicting surgical outcomes following microvascular decompression (MVD) in patients with hemifacial spasm. Methods Seventy-three patients with hemifacial spasm underwent MVD with intraoperative LSR monitoring. Surgical outcomes were evaluated 1 week and 1 year after MVD and correlations between LSR characteristics and surgical outcomes were analyzed. Results The LSR disappeared completely in 61 patients during surgery (Group A; prior to insertion of Teflon felt pledgets in 11, after insertion of pledgets in 50), disappeared partially in nine patients (Group B), and remained unchanged in three patients (Group C). Fifty-five patients showed short-term and 61 patients showed long-term clinical cures during the follow-up period. The short-term and long-term cure rates were significantly higher in Group A than in Group C. There was no correlation between the time of complete LSR disappearance and surgical outcomes. Conclusions Disappearance of the LSR during MVD is correlated with the surgical outcomes. Intraoperative LSR monitoring is a reliable approach for predicting the prognosis of hemifacial spasm following MVD, but the time at which LSR disappears is not a prognostic indicator.

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Prognostic value of the lateral spread response for intraoperative electromyography monitoring of the facial musculature during microvascular decompression for hemifacial spasm

Journal of Neurosurgery ◽

10.3171/jns.2007.106.3.384 ◽

2007 ◽

Vol 106 (3) ◽

pp. 384-387 ◽

Cited By ~ 70

Author(s):

Doo-Sik Kong ◽

Kwan Park ◽

Byoung-gook Shin ◽

Jeong Ah Lee ◽

Dong-Ok Eum

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Prognostic Indicator ◽

Lateral Spread ◽

Facial Emg ◽

Facial Musculature ◽

Group I ◽

Significant Difference ◽

Lateral Spread Response

Object The authors conducted a large retrospective study in which they evaluated the efficacy of intraoperative electromyography (EMG) monitoring of facial musculature during microvascular decompression (MVD) and assessed the predictive value of the lateral spread response (LSR) as a prognostic indicator for the treatment outcome of hemifacial spasm (HFS). Methods The authors undertook intraoperative monitoring during MVD in 300 consecutive patients with HFS. The patients were divided into two groups based on whether the LSR disappeared or persisted following decompression. The mean follow-up period was 35.8 months (range 12–55 months). In 263 (87.7%) of the 300 patients, the LSR was observed during intraoperative facial EMG monitoring. In 230 (87.4%) of these 263 patients, the LSR disappeared following decompression (Group I), and in the remaining 33 patients (12.5%) the LSR persisted despite decompression (Group II). At the postoperative 1-year follow-up visit, there was a significant difference in clinical outcomes between both groups (p < 0.05). Conclusions Facial EMG monitoring of the LSR is an effective tool to use when performing complete decompression, and it may be helpful in predicting outcomes.

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