Subscribe to RSS
DOI: 10.1055/s-0034-1368145
The Significance of Intraoperative Electromyographic “Lateral Spread” in Predicting Outcome of Microvascular Decompression for Hemifacial Spasm
Publication History
29 June 2013
24 November 2013
Publication Date:
12 March 2014 (online)
![](https://www.thieme-connect.de/media/jnlsb/201403/lookinside/thumbnails/10.1055-s-0034-1368145-1.jpg)
Abstract
Objectives During microvascular decompression (MVD) of the facial nerve for hemifacial spasm (HFS), an abnormal muscle response can be recorded upon stimulation of the facial nerve, also known as the lateral spread response. This response may vanish after MVD and has been associated with a successful outcome. The purpose of this study was to determine if resolution of lateral spread correlated with the elimination of HFS in a single surgeon's experience.
Design and Setting (1) Retrospective analysis of 38 patients undergoing MVD with intraoperative electromyography for HFS. (2) Meta-analysis of studies from the literature.
Main Outcome Measure Presence or absence of HFS and any complications.
Results Lateral spread response was seen in 36 patients; 20 patients had full resolution. Of these, 15 patients became HFS free, and 5 five patients still had some degree of HFS. Sixteen patients had a persistent lateral spread response despite a technically successful MVD; 11 of these became spasm free, and 5 still suffered from some degree of facial twitching. Analyzing 16 studies reporting a total of 1301 patients, a significant correlation (p < 0.0001) between response cessation and resolution of HFS was found.
Conclusion The role of monitoring lateral spread response as a predictor for clinical outcome is limited.
-
References
- 1 Wang A, Jankovic J. Hemifacial spasm: clinical findings and treatment. Muscle Nerve 1998; 21 (12) 1740-1747
- 2 Jannetta PJ, Abbasy M, Maroon JC, Ramos FM, Albin MS. Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients. J Neurosurg 1977; 47 (3) 321-328
- 3 Auger RG, Piepgras DG, Laws Jr ER, Miller RH. Microvascular decompression of the facial nerve for hemifacial spasm: clinical and electrophysiologic observations. Neurology 1981; 31 (3) 346-350
- 4 Hyun SJ, Kong DS, Park K. Microvascular decompression for treating hemifacial spasm: lessons learned from a prospective study of 1,174 operations. Neurosurg Rev 2010; 33 (3) 325-334 ; discussion 334
- 5 Shin JC, Kim YC, Park CI, Chung UH. Intraoperative monitoring of microvascular decompression in hemifacial spasm. Yonsei Med J 1996; 37 (3) 209-213
- 6 Møller AR, Jannetta PJ. Physiological abnormalities in hemifacial spasm studied during microvascular decompression operations. Exp Neurol 1986; 93 (3) 584-600
- 7 Yamashita S, Kawaguchi T, Fukuda M , et al. Lateral spread response elicited by double stimulation in patients with hemifacial spasm. Muscle Nerve 2002; 25 (6) 845-849
- 8 Ishikawa M, Namiki J, Takase M, Ohira T, Nakamura A, Toya S. Effect of repetitive stimulation on lateral spreads and F-waves in hemifacial spasm. J Neurol Sci 1996; 142 (1–2) 99-106
- 9 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 (1) 24-32
- 10 Wilkinson MF, Kaufmann AM. Monitoring of facial muscle motor evoked potentials during microvascular decompression for hemifacial spasm: evidence of changes in motor neuron excitability. J Neurosurg 2005; 103 (1) 64-69
- 11 Møller AR, Jannetta PJ. Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm. J Neurosurg 1987; 66 (5) 681-685
- 12 Huang BR, Chang CN, Hsu JC. Intraoperative electrophysiological monitoring in microvascular decompression for hemifacial spasm. J Clin Neurosci 2009; 16 (2) 209-213
- 13 Neves DO, Lefaucheur JP, de Andrade DC , et al. A reappraisal of the value of lateral spread response monitoring in the treatment of hemifacial spasm by microvascular decompression. J Neurol Neurosurg Psychiatry 2009; 80 (12) 1375-1380
- 14 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 (9) 933-937 ; discussion 937–938
- 15 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 (3) 384-387
- 16 Isu T, Kamada K, Mabuchi S , et al. Intra-operative monitoring by facial electromyographic responses during microvascular decompressive surgery for hemifacial spasm. Acta Neurochir (Wien) 1996; 138 (1) 19-23 ; discussion 23
- 17 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 (6) 496-499
- 18 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 (4) 365-368
- 19 Thirumala PD, Shah AC, Nikonow TN , et al. Microvascular decompression for hemifacial spasm: evaluating outcome prognosticators including the value of intraoperative lateral spread response monitoring and clinical characteristics in 293 patients. J Clin Neurophysiol 2011; 28 (1) 56-66
- 20 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 (12) 1335-1339
- 21 Li J, Zhang Y, Zhu H, Li Y. Prognostic value of intra-operative abnormal muscle response monitoring during microvascular decompression for long-term outcome of hemifacial spasm. J Clin Neurosci 2012; 19 (1) 44-48
- 22 Sekula Jr RF, Bhatia S, Frederickson AM , et al. Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis. Neurosurg Focus 2009; 27 (4) E10
- 23 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (2) 146-147
- 24 Haines SJ, Torres F. Intraoperative monitoring of the facial nerve during decompressive surgery for hemifacial spasm. J Neurosurg 1991; 74 (2) 254-257
- 25 Shin JC, Chung UH, Kim YC, Park CI. Prospective study of microvascular decompression in hemifacial spasm. Neurosurgery 1997; 40 (4) 730-734 ; discussion 734–735
- 26 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 (6) 1581-1587 ; discussion 1587–1588
- 27 Yuan Y, Wang Y, Zhang SX, Zhang L, Li R, Guo J. Microvascular decompression in patients with hemifacial spasm: report of 1200 cases. Chin Med J (Engl) 2005; 118 (10) 833-836
- 28 Chung SS, Chang JH, Choi JY, Chang JW, Park YG. Microvascular decompression for hemifacial spasm: a long-term follow-up of 1,169 consecutive cases. Stereotact Funct Neurosurg 2001; 77 (1-4) 190-193
- 29 Tan EK, Fook-Chong S, Lum SY, Thumboo J. Validation of a short disease specific quality of life scale for hemifacial spasm: correlation with SF-36. J Neurol Neurosurg Psychiatry 2005; 76 (12) 1707-1710
- 30 Mooij JJ, Mustafa MK, van Weerden TW. Hemifacial spasm: intraoperative electromyographic monitoring as a guide for microvascular decompression. Neurosurgery 2001; 49 (6) 1365-1370 ; discussion 1370–1371
- 31 Habeych ME, Shah AC, Nikonow TN , et al. Effect of botulinum neurotoxin treatment in the lateral spread monitoring of microvascular decompression for hemifacial spasm. Muscle Nerve 2011; 44 (4) 518-524