Predicting outcome of hemifacial spasm after microvascular decompression with intraoperative monitoring: A systematic review

Nugroho, Setyo Widi; Perkasa, Sayyid Abdil Hakam; Gunawan, Kevin; Manuhutu, Yovanka Naryai; Rahman, Muhamad Aulia; Rizky, Amal

doi:10.1016/j.heliyon.2021.e06115

Cited by 10 publications

(7 citation statements)

References 47 publications

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“…In a prospective study, Wei et al showed no significant difference in clinical outcomes between two groups undergoing MVD with and without IOM [11]. A systematic review by Nugroho et al demonstrated that LSR disappearance may be an independent predictor of short-term outcomes but not a reliable predictor of long-term outcomes [26]. These studies have been conducted under the premise that LSR could be evoked initially and correctly reflected the situation of facial nerve being compressed.…”

Section: Discussionmentioning

confidence: 99%

Predicting Early Loss of Lateral Spread Response before Decompression in Hemifacial Spasm Surgery

Chan

Chiang

Chen

et al. 2021

Life

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Recent studies have shown the evocation of lateral spread response (LSR) due to the compression of the facial nerve in hemifacial spasm (HFS). Intraoperative monitoring (IOM) of LSR could help locate neurovascular conflicts and confirm adequate micro-vascular decompression (MVD) while treatment of hemifacial spasm (HFS). However, studies on early LSR loss before decompression in HFS surgery are sparse, indicating the need to understand various perceptions on it. Therefore, we retrospectively analyzed 50 adult HFS patients who underwent MVD during the period of September 2018–June 2021. We employed IOM combining traditional LSR (tLSR) and dual LSR (dLSR). One patient was excluded owing to the lack of LSR induction throughout the surgery, while 49 were divided into groups A (n = 14) and B (n = 35), designated as with or without early LSR loss groups, respectively, and offending vessels were analyzed. The mean age of group A patients was significantly younger (47.8 ± 8.6) than that of group B (53.9 ± 10.6) (p = 0.0393). The significant predominating offending vessel in group A was the anterior inferior cerebellar artery (AICA, 78.57%). However, group B included those with AICA (28.57%), posterior inferior cerebellar artery (PICA, 22.86%), vertebral artery (VA) involved (25.71%), and combined AICA and PICA (22.86%). Group B exhibited poorer clinical outcomes with more complications. Conclusively, early LSR loss might occur in the younger population, possibly due to the AICA offending vessel. The compression severity of offending vessels may determine the occurrence of early LSR loss.

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Section: Discussionmentioning

confidence: 99%

Predicting Early Loss of Lateral Spread Response before Decompression in Hemifacial Spasm Surgery

Chan

Chiang

Chen

et al. 2021

Life

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“…The monitoring of LSR does not interfere with the surgical process, allowing for continuous observation while manipulating the facial nerve and adjacent vessels. Generally, monitoring of LSR begins after the insertion of electrodes, before dural opening, after dural opening, during REZ decompression, and after dural closure [ 4 ]. Even if LSR disappears immediately after dural opening or decompression, its recurrence may indicate unsuccessful decompression.…”

Section: Methods For Monitoring Lateral Spread Response (Lsr)mentioning

confidence: 99%

“…However, they did not find a significant predictive effect on long-term outcomes. Another systematic review, by Nugroho [ 4 ], also concluded that short-term outcomes are strongly correlated with the resolution of LSR. However, the resolution of LSR does not significantly impact long-term outcomes, as patient outcomes tend to improve over time with adequate decompression, even if LSR persists after surgery.…”

Section: Prognostic Value Of Lsrmentioning

confidence: 99%

Lateral Spread Response: Unveiling the Smoking Gun for Cured Hemifacial Spasm

Cho,

Park,

Park

2023

Life

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Hemifacial spasm (HFS) is a rare disorder characterized by involuntary facial muscle contractions. The primary cause is mechanical compression of the facial nerve by nearby structures. Lateral spread response (LSR) is an abnormal muscle response observed during electromyogram (EMG) testing and is associated with HFS. Intraoperative monitoring of LSR is crucial during surgery to confirm successful decompression. Proper anesthesia and electrode positioning are important for accurate LSR monitoring. Stimulation parameters should be carefully adjusted to avoid artifacts. The disappearance of LSR during surgery is associated with short-term outcomes, but its persistence does not necessarily indicate poor long-term outcomes. LSR monitoring has both positive and negative prognostic value, and its predictive ability varies across studies. Early disappearance of LSR can occur before decompression and may indicate better clinical outcomes. Further research is needed to fully understand the implications of LSR monitoring in HFS surgery.

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“…Persistent response carries a high risk of persistent hemifacial spasm. The disappearance of LSR during MVD can be a useful tool to predict resolution of symptom shortly after surgery [15]. Although LSR monitoring has limited value in predicting prognosis, it appears to have favorable outcome in short-term period, on the other hand, it does not appear to be effective in predicting the outcome in long-term period [14,15].…”

Section: ) Lateral Spread Response (Lsr) and Effectiveness Of Microvascular Decompression (Mvd)mentioning

confidence: 99%

반얼굴연축에서 미세혈관감압 수술중 신경계감시

Yong¹

2021

J Intraoper Neurophysiol

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The majority of primary hemifacial spasm (HFS) patients are related to a vascular compression of the facial nerve root at its entry zone. Non-surgical treatment methods of HFS are anti-epileptic drugs and local botulinum toxin injection, but their outcomes are often not satisfactory in relieving symptoms. Microvascular decompression (MVD) is a surgical treatment method of HFS. Nowadays, intraoperative neurophysiologic monitoring is being used during MVD for two main objectives. The first and main objective is to prevent and reduce the risk of hearing impairment. Brainstem auditory evoked potentials (BAEPs) is monitored during surgery, to monitor the cranial nerve VIII and determine hearing sense preservation. Researches on BAEPs has enabled near real-time and safe monitoring, as warning indicators and advanced techniques to get results faster has been discovered. The second objective is to optimize the effectiveness of surgery. Despite the surgery, some patients had persisted symptoms or recurrence of spasm for some reasons, in few cases. The lateral spread response (LSR) monitoring is performed to guide the operator during surgery. LSR shows modest sensitivity. Nevertheless, it shows high specificity in predicting the symptom-free status after MVD. Low sensitivity precluded the use of the LSR monitoring as an exclusive solitary diagnostic modality. The disappearance of LSR during MVD appears to be not effectively in predicting long-term outcomes, but it demonstrated limited prognostic values in predicting favorable short-term outcomes. These results implements that, intraoperative monitoring of LSR during MVD can provide considerable value for investigating the adequacy of MVD before cranial bone closure.

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Predicting outcome of hemifacial spasm after microvascular decompression with intraoperative monitoring: A systematic review

Cited by 10 publications

References 47 publications

Predicting Early Loss of Lateral Spread Response before Decompression in Hemifacial Spasm Surgery

Predicting Early Loss of Lateral Spread Response before Decompression in Hemifacial Spasm Surgery

Lateral Spread Response: Unveiling the Smoking Gun for Cured Hemifacial Spasm

반얼굴연축에서 미세혈관감압 수술중 신경계감시

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