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Microvascular decompression (MVD) has come to stay as an effective way of treating hemifacial spasm. But it remains to be seen how much each of the electrophysiological monitoring techniques (intra-operative) are contributing to its increased efficacy. Their role as indicators for re-exploration or recurrence is to be evaluated with more studies. We have used the lateral spread response in those patients who had distinctly abnormal recording on the ipsilateral side, studied the intra-operative changes during MVD and correlated with the outcome of surgery. 38 patients operated for HFS, were selected for intra-operative monitoring of abnormal muscle responses. In 17 patients, there was persistence of abnormal muscle responses in the immediate postoperative period and only 6 of them had mild HFS. Two of 21 patients who had disappearance of abnormal responses had persistent mild HFS; but in all cases, the HFS disappeared within 3 months. So we found that the intra-operative recording was really not reliable in predicting the immediate postoperative outcome. However the outcome at 3 months suggested that waiting for some time before re-exploration is a better option, especially if the HFS had become mild.

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A 68-year-old female presented with Waldenstrom's macroglobulinemia with infiltration into the cerebral parenchyma manifesting as increased confusion, memory loss, and disorientation. She had a past history of Waldenstrom's macroglobulinemia treated 3 years before. Magnetic resonance imaging showed a high intensity area on T2-weighted images in the left frontal lobe extending to the corpus callosum which was well enhanced by gadolinium-diethylenetriaminepenta-acetic acid. Direct infiltration of neoplastic cells was confirmed by biopsy. Immunohistochemical examination showed that mature plasmacytoid cells in the cerebral parenchyma were immunoglobulin M and lambda light chain antigen positive, but immature lymphocytes in Virchow-Robin space were negative. Monoclonal proliferation was confirmed by southern blot analysis. She became symptom free and the size of the lesion was dramatically reduced after 40 Gy irradiation. She showed no evidence of recurrence 3 years after irradiation. As no effective chemotherapy regimen for Bing-Neel syndrome has been established, irradiation is worth considering when neuroimaging suggests intracranial infiltration of neoplastic cells.