Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis

Sekula, Raymond F.; Bhatia, Sanjay; Frederickson, Andrew M.; Jannetta, Peter J.; Quigley, Matthew R.; Small, George A.; Breisinger, Ryan

doi:10.3171/2009.8.focus09142

Cited by 83 publications

(81 citation statements)

References 29 publications

(41 reference statements)

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“…There were numerous examples of meta-analyses at both ends of the overall quality spectrum. 12,13,16,24,37,43,49,89,96,101,105 Surprisingly, experience in performing a meta-analysis also did not ensure that it was of higher overall quality. For example, authors from a single institution produced no less than 8 meta-analyses with deficiencies that were often repeated from one paper to the next.…”

Section: Our Resultsmentioning

confidence: 99%

Methodology and reporting of meta-analyses in the neurosurgical literature

Klimo

Thompson

Ragel

et al. 2014

JNS

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Object. Neurosurgeons are inundated with vast amounts of new clinical research on a daily basis, making it difficult and time-consuming to keep up with the latest literature. Meta-analysis is an extension of a systematic review that employs statistical techniques to pool the data from the literature in order to calculate a cumulative effect size. This is done to answer a clearly defined a priori question. Despite their increasing popularity in the neurosurgery literature, meta-analyses have not been scrutinized in terms of reporting and methodology.Methods. The authors performed a literature search using PubMed/MEDLINE to locate all meta-analyses that have been published in the JNS Publishing Group journals (Journal of Neurosurgery, Journal of Neurosurgery: Pediatrics, Journal of Neurosurgery: Spine, and Neurosurgical Focus) or Neurosurgery. Accepted checklists for reporting (PRISMA) and methodology (AMSTAR) were applied to each meta-analysis, and the number of items within each checklist that were satisfactorily fulfilled was recorded. The authors sought to answer 4 specific questions: Are meta-analyses improving 1) with time; 2) when the study met their definition of a meta-analysis; 3) when clinicians collaborated with a potential expert in meta-analysis; and 4) when the meta-analysis was the only focus of the paper?Results. Seventy-two meta-analyses were published in the JNS Publishing Group journals and Neurosurgery between 1990 and 2012. The number of published meta-analyses has increased dramatically in the last several years. The most common topics were vascular, and most were based on observational studies. Only 11 papers were prepared using an established checklist. The average AMSTAR and PRISMA scores (proportion of items satisfactorily fulfilled divided by the total number of eligible items in the respective instrument) were 31% and 55%, respectively. Major deficiencies were identified, including the lack of a comprehensive search strategy, study selection and data extraction, assessment of heterogeneity, publication bias, and study quality. Almost one-third of the papers did not meet our basic definition of a meta-analysis. The quality of reporting and methodology was better 1) when the study met our definition of a meta-analysis; 2) when one or more of the authors had experience or expertise in conducting a meta-analysis; 3) when the meta-analysis was not conducted alongside an evaluation of the authors' own data; and 4) in more recent studies.Conclusions. Reporting and methodology of meta-analyses in the neurosurgery literature is excessively variable and overall poor. As these papers are being published with increasing frequency, neurosurgical journals need to adopt a clear definition of a meta-analysis and insist that they be created using checklists for both reporting and methodology. Standardization will ensure high-quality publications.

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Section: Our Resultsmentioning

confidence: 99%

Methodology and reporting of meta-analyses in the neurosurgical literature

Klimo

Thompson

Ragel

et al. 2014

JNS

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“…All patients presenting with clinical features of HFS underwent preoperative electromyography testing for detection of an abnormal motor response or "lateral spread" elicited via stimulation of the zygomatic branch of the facial nerve and recorded from the mentalis muscle, confirming the diagnosis. 22 At this time, patients also underwent preoperative brainstem auditory evoked potential (BAEP) testing. All patients underwent thin-slice T2-weighted MRI to evaluate vascular compression along the centrally myelinated portion of the facial nerve.…”

Section: Methods Patient Selectionmentioning

confidence: 99%

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Frederickson

Balzer

Crammond

et al. 2015

JNS

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M icrovascular decompression (MVD) is a safe and efficacious procedure for the treatment of hemifacial spasm (HFS), a debilitating condition that reduces patients' quality of life. Severe sensorineural hearing loss (SNHL) across all frequencies is a known complication of the operation, with reported rates ranging from 1.4% to 20%. 4,12,[18][19][20][21]24 In addition to severe SNHL, however, a recent report has raised concern that as many as one-half of patients undergoing MVD for HFS may experience high-frequency (4-8 kHz) hearing loss.28 Although this type of hearing loss is not as obviously apparent upon clinical follow-up as severe SNHL, high-frequency hearing loss (HFHL) can profoundly reduce the quality of life of patients. 5,10 Although the prior report implicated noise from the high-speed surgical drill as the cause of HFHL following MVD, we conducted this study to examine the incidence of HFHL, with an emphasis on retractorless MVD for treatment of HFS.abbreviatioNs BAEP = brainstem auditory evoked potential; HFHL = high-frequency hearing loss; HFS = hemifacial spasm; MVD = microvascular decompression; SNHL = sensorineural hearing loss; SPL = sound pressure level. obJect Microvascular decompression is a safe and effective procedure to treat hemifacial spasm, but the operation poses some risk to the patient's hearing. While severe sensorineural hearing loss across all frequencies occurs at a low rate in experienced hands, a recent study suggests that as many as one-half of patients who undergo this procedure may experience ipsilateral high-frequency hearing loss (HFHL), and as many as one-quarter may experience contralateral HFHL. While it has been suggested that drill-related noise may account for this finding, this study was designed to examine the effect of a number of techniques designed to protect the vestibulocochlear nerve from operative manipulation on the incidence of HFHL. methods Pure-tone audiometry was performed both preoperatively and postoperatively on 67 patients who underwent microvascular decompression for hemifacial spasm during the study period. A change of greater than 10 dB at either 4 kHz or 8 kHz was considered to be HFHL. Additionally, the authors analyzed intraoperative brainstem auditory evoked potentials from this patient cohort. results The incidence of ipsilateral HFHL in this cohort was 7.4%, while the incidence of contralateral HFHL was 4.5%. One patient (1.5%; also included in the HFHL group) experienced an ipsilateral nonserviceable hearing loss. coNclusioNs The reduced incidence of HFHL in this study suggests that technical modifications including performing the procedure without the use of fixed retraction may greatly reduce, but not eliminate, the occurrence of HFHL following microvascular decompression for hemifacial spasm.

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“…[11,15,18] Zhong et al stressed that a reoperation should be performed as soon as possible instead of expecting a delayed cure. They didn't observe any delayed cure during the 1 year follow-up period for those with persistent spasm patients.…”

Section: Assessment Of Persistent Spasm After Mvdmentioning

confidence: 99%

A significant correlation between delayed cure after microvascular decompression and positive response to preoperative anticonvulsant therapy in patients with hemifacial spasm

et al. 2016

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Delayed cure and anticonvulsant therapy 2 ABSTRACT (150-250 words) ObjectiveAlthough microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), the postoperative course is varied. We retrospectively analyzed the resolution pattern of the spasm and specified predictors for delayed cure after MVD. MethodsThis study included 114 consecutive patients with typical HFS. All of them were followed-up for at least one year after operation. Patients were divided into three groups depending on the postoperative course:immediate cure, delayed cure, and failure. To identify the predictive factors for delayed cure after MVD, logistic regression analyses were applied using candidate clinical factors, such as duration of symptom, the tendency of the spasm, preoperative medical treatment and offending vessels. ResultsAmong the 114 patients, 107 patients were cured. For those cured, 65 patients were classified as immediate cure and 42 patients were classified as delayed cure. Cumulative spasm free rate after one week, one month, and 3 months after MVD were 70%, 88%, and 97%, respectively. No predictive factors between the cured and failure groups were observed. According to multivariate analysis, preoperative anticonvulsant therapy was found to be the sole significant predictive factor for delayed cure after MVD (p = 0.025). ConclusionsA significant correlation between delayed cure and preoperative anticonvulsant therapy was found in our study, which suggests that hyperexcitation of the facial nucleus plays an important role in pathogenesis of delayed cure. Therefore, if a patient demonstrating a positive response to preoperative anticonvulsant therapy showed a persistent spasm after MVD, reoperation should be delayed for at least 3 months after the initial operation.

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Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis

Cited by 83 publications

References 29 publications

Methodology and reporting of meta-analyses in the neurosurgical literature

Methodology and reporting of meta-analyses in the neurosurgical literature

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

A significant correlation between delayed cure after microvascular decompression and positive response to preoperative anticonvulsant therapy in patients with hemifacial spasm

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