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Liang H, Liu J, Wang M, Luo G, Zhang Y. Mapping trends in hemifacial spasm research: bibliometric and visualization-based analyses of the Web of Science Core Collection. Neurosurg Rev 2024; 47:55. [PMID: 38243012 DOI: 10.1007/s10143-024-02294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
Hemifacial spasm (HFS) is a common cranial nerve disease. In HFS research, we conducted a bibliometric analysis to examine the development and research trends. A retrieval of HFS studies published between 2011 and 2022 was performed from the Web of Science Core Collection in September 2022. Two scientometric tools were used to perform bibliometric and visualization-based analyses: VOSviewer and CiteSpace. Bibliometric analysis of 1461 studies published between 2011 and 2022 was carried out using data from 444 journals, 6021 authors, 1732 institutions, and 76 countries/regions. China, the USA, Japan, and South Korea were four key contributors to this study. Shanghai Jiaotong University was the major institution with the larger number of publications. Li Shiting was the most prolific author. Jannetta PJ was the most co-cited author. World Neurosurgery was the top prolific journal. Journal of Neurosurgery was the top co-cited journal. The top five keywords were hemifacial spasm, microvascular decompression, trigeminal neuralgia, surgery, and neurovascular compression. This study examines the research trends in global scientific research on HFS over the last decade. Researchers interested in learning more about current trends and novel research frontiers in this area can benefit from the study.
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Affiliation(s)
- Hao Liang
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, 510317, Guangdong, China
| | - Jiawen Liu
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China
| | - Mo Wang
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China
| | - Guoxuan Luo
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China.
| | - Yong Zhang
- Department of Neurosurgery, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, 510317, Guangdong, China.
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, 510317, Guangdong, China.
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Cho KR, Lee HS, Kim M, Park SK, Park K. Optimal method for reliable lateral spread response monitoring during microvascular decompression surgery for hemifacial spasm. Sci Rep 2023; 13:21672. [PMID: 38066203 PMCID: PMC10709590 DOI: 10.1038/s41598-023-49008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
In this study, we propose an optimal method for monitoring the key electrophysiological sign, the Lateral Spread Response (LSR), during microvascular decompression (MVD) surgery for hemifacial spasm (HFS). Current monitoring methods and interpretations of LSR remain unclear, leading to potential misinterpretations and undesirable outcomes." We prospectively collected data from patients undergoing MVD for HFS, including basic demographics, clinical characteristics, and surgical outcomes. Stimulation intensity was escalated by 1 mA increments to identify the optimal range for effective LSR. We designated the threshold at which we can observe LSR as THR1 and THR2 for when LSR disappears, with high-intensity stimulation (30 mA) designated as THR30. Subsequently, we compared abnormal muscle responses (AMR) between the optimal range (between THR1 and THR2) and THR30. Additionally, we conducted an analysis to identify and assess factors associated with artifacts and their potential impact on clinical outcomes. As stimulation intensity increases, the onset latency to detect AMR was shortened. The first finding of the study was high intensity stimulation caused artifact that mimic the wave of LSR. Those artifacts were observed even after decompression thus interfere interpretation of disappearance of LSR. Analyzing the factors related to the artifact, we found the AMR detected at onset latency below 9.6 ms would be the lateral spreading artifact (LSA) rather than true LSR. To avoid false positive LSR from LSA, we should stepwise increase stimulation intensity and not to surpass the intensity that cause LSR onset latency below 10 ms.
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Affiliation(s)
- Kyung Rae Cho
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea
| | - Hyun-Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, 25440, Republic of Korea
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea.
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea.
- Department of Neurosurgery, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
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Cho KR, Park SK, Park K. Lateral Spread Response: Unveiling the Smoking Gun for Cured Hemifacial Spasm. Life (Basel) 2023; 13:1825. [PMID: 37763229 PMCID: PMC10532564 DOI: 10.3390/life13091825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/11/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
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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Affiliation(s)
- Kyung Rae Cho
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (K.R.C.); (S.K.P.)
| | - Sang Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (K.R.C.); (S.K.P.)
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (K.R.C.); (S.K.P.)
- Department of Neurosurgery, School of Medicine Sungkyunkwan University, Seoul 16419, Republic of Korea
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Jeon C, Jung NY, Kim M, Park K. Intraoperative Monitoring of the Facial Nerve during Microvascular Decompression for Hemifacial Spasm. Life (Basel) 2023; 13:1616. [PMID: 37511991 PMCID: PMC10381659 DOI: 10.3390/life13071616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
This review article discusses the clinical significance of intraoperative neurophysiological monitoring (IONM), provides recommendations for monitoring protocols, and considers the interpretation of results in microvascular decompression (MVD) for hemifacial spasm (HFS). The lateral spread response (LSR) is an important monitoring parameter during MVD. It helps to identify the responsible blood vessel and confirms its thorough decompression from the facial nerve. The disappearance of the LSR during surgery is associated with favorable clinical outcomes. Standard and revised monitoring protocols and the confirmation of LSR persistence and disappearance are also discussed. The blink reflex and other facial nerve monitoring modalities, such as free-running electromyography, facial motor evoked potentials, F-waves, and the Z-L response, are further considered.
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Affiliation(s)
- Chiman Jeon
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
| | - Na Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung 25440, Republic of Korea
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
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Joo BE, Kim JS, Deletis V, Park KS. Advances in Intraoperative Neurophysiology During Microvascular Decompression Surgery for Hemifacial Spasm. J Clin Neurol 2022; 18:410-420. [PMID: 35796266 PMCID: PMC9262452 DOI: 10.3988/jcn.2022.18.4.410] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/03/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Microvascular decompression (MVD) is a widely used surgical intervention to relieve the abnormal compression of a facial nerve caused by an artery or vein that results in hemifacial spasm (HFS). Various intraoperative neurophysiologic monitoring (ION) and mapping methodologies have been used since the 1980s, including brainstem auditory evoked potentials, lateral-spread responses, Z-L responses, facial corticobulbar motor evoked potentials, and blink reflexes. These methods have been applied to detect neuronal damage, to optimize the successful decompression of a facial nerve, to predict clinical outcomes, and to identify changes in the excitability of a facial nerve and its nucleus during MVD. This has resulted in multiple studies continuously investigating the clinical application of ION during MVD in patients with HFS. In this study we aimed to review the specific advances in methodologies and clinical research related to ION techniques used in MVD surgery for HFS over the last decade. These advances have enabled clinicians to improve the efficacy and surgical outcomes of MVD, and they provide deeper insight into the pathophysiology of the disease.
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Affiliation(s)
- Byung-Euk Joo
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Vedran Deletis
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia and Albert Einstein College of Medicine, New York, NY, USA
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Kim M, Cho KR, Park SK, Jeon C, Park K. Prognostic Value of Lateral Spread Response Recorded 1 Month After Microvascular Decompression for the Treatment of Hemifacial Spasm. Neurosurgery 2022; 91:159-166. [PMID: 35383685 DOI: 10.1227/neu.0000000000001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/30/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The predictive value of intraoperative disappearance of the lateral spread response (LSR) during microvascular decompression surgery for hemifacial spasm treatment is unclear. Studies evaluating the clinical implications of the LSR recorded during the postoperative period are also limited. OBJECTIVE To analyze the LSR 1 month postoperatively and to evaluate its prognostic value until 1 year postsurgery. METHODS In total, 883 patients who underwent microvascular decompression between 2016 and 2018 were included. LSR was recorded preoperatively, intraoperatively before decompression, intraoperatively after decompression, and 1 month postoperatively. The outcomes were evaluated at 1 week, 1 month, and 1 year postoperatively. RESULTS The presence of preoperative and intraoperative LSR after decompression did not predict the postoperative outcome at 1 year. In 246 patients (27.9%), the postoperative LSR at 1 month was not identical to that recorded intraoperatively after decompression. Postoperative LSR at 1 month was associated with a worse outcome at 1 month (P < .0001) and 1 year (P = .0002) postoperatively. Patients with residual symptoms and a LSR 1 month postoperatively were more likely to show residual symptoms 1 year postoperatively, with a positive predictive value of 50.7%. CONCLUSION Unlike the intraoperative LSR, the LSR at 1 month postoperatively showed prognostic value in predicting 1-year postoperative outcomes and was useful for identifying patients with a high risk of unfavorable outcomes. Thus, confirming the presence of postoperative LSR is necessary.
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Affiliation(s)
- Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung, Republic of Korea.,Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyung Rae Cho
- Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea.,Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Chiman Jeon
- Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Republic of Korea.,Department of Neurosurgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Sprenghers L, Lemmens R, van Loon J. Usefulness of intraoperative monitoring in microvascular decompression for hemifacial spasm: a systematic review and meta-analysis. Br J Neurosurg 2022; 36:346-357. [PMID: 35313771 DOI: 10.1080/02688697.2022.2049701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To review the diagnostic accuracy and possible added value of Brainstem Auditory Evoked Potentials (BAEP) monitoring and Lateral Spread Response (LSR) monitoring in microvascular decompression surgery for hemifacial spasms. METHODS For this systematic review we followed the PRISMA guidelines. We searched different databases and bibliographies of articles. We included studies on BAEP and LSR monitoring that reported data on hearing outcome or efficacy. Selected studies were assessed for bias using the MINORS tool. RESULTS 64 articles were selected for qualitative synthesis, 42 met inclusion criteria for meta-analysis. The overall incidence of hearing loss was 3.4%. For BAEP monitoring AUC and pooled OR with 95% confidence interval were 0.911 (0.753-0.933) and 7.99 (3.85-16.60) respectively. Short-term data on LSR monitoring showed an overall spasm relief rate of 89% with pooled OR, sensitivity and specificity with a 95% confidence interval of 8.80 (4.82-16.08), 0.911 (0.863-0.943) and 0.451 (0.342-0.564) respectively. Long-term data on LSR monitoring showed an overall spasm relief rate of 95% with pooled OR, sensitivity and specificity with a 95% confidence interval of 4.06 (2.15-7.64), 0.871 (0.817-0.911) and 0.39 (0.294-0.495) respectively. CONCLUSION The alarm criteria, a wave V latency prolongation of 1ms or a wave V amplitude decrement of 50%, proposed by the 'American Clinical Neurophysiology Society' are a sensitive predictor for postoperative hearing loss. Other BAEP wave changes, for example, complete loss of wave V, are more specific but correspond to irreversible damage and are therefore not useful as warning criteria. LSR monitoring has high diagnostic accuracy at short-term follow-up. At long-term follow-up, diagnostic accuracy decreases because most patients get spasm relief regardless of their LSR status. LSR persistence after surgery has a good long-term outcome, as long as an extensive exploration of the facial nerve has been performed.
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Affiliation(s)
| | - Robin Lemmens
- Department of Neurology, University Hospital Leuven, University of Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospital Leuven and Laboratory of Experimental Neurosurgery and Neuroanatomy, University of Leuven, Leuven, Belgium
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A multivariable prediction model for recovery patterns and time course of symptoms improvement in hemifacial spasm following microvascular decompression. Acta Neurochir (Wien) 2022; 164:833-844. [PMID: 35103860 PMCID: PMC8913470 DOI: 10.1007/s00701-022-05133-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Microvascular decompression (MVD) success rates exceed 90% in hemifacial spasm (HFS). However, postoperative recovery patterns and durations are variable. OBJECTIVE We aim to study factors that might influence the postoperative patterns and duration needed until final recovery. METHOD Only patients following de-novo MVD with a minimum follow-up of 6 months were included. Overall trend of recovery was modeled. Patients were grouped according to recognizable clinical recovery patterns. Uni- and multivariable analyses were used to identify the factors affecting allocation to the identified patterns and time needed to final recovery. RESULTS A total of 323 (92.6%) patients had > 90% symptom improvement, and 269 (77.1%) patients had complete resolution at the last follow-up. The overall trend of recovery showed steep remission within the first 6 months, followed by relapse peaking around 8 months with a second remission ~ 16 months. Five main recovery patterns were identified. Pattern analysis showed that evident proximal indentation of the facial nerve at root exit zone (REZ), males and facial palsy are associated with earlier recovery at multivariable and univariable levels. anterior inferior cerebellar artery (AICA), AICA/vertebral artery compressions and shorter disease durations are related to immediate resolution of the symptoms only on the univariable level. Time analysis showed that proximal indentation (vs. distal indentation), males and facial palsy witnessed significantly earlier recoveries. CONCLUSION Our main finding is that in contrast to peripheral indentation, proximal indentation of the facial nerve at REZ is associated with earlier recovery. Postoperative facial palsy and AICA compressions are associated with earlier recoveries. We recommend a minimum of 1 year before evaluating the final outcome of MVD for HFS.
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An Unusual Abnormal Muscular Response During Microvascular Decompression Under Endoscope Assistance. J Craniofac Surg 2021; 33:e390-e392. [PMID: 34611105 DOI: 10.1097/scs.0000000000008264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Abnormal muscular response (AMR) has been widely used in the intraoperative monitoring of microvascular decompression due to its advantages for the identification of responsible arteries and the evaluation of adequate decompression. Here the authors report a 48-year-old man with an unusual AMR during microvascular decompression under endoscope assistance. The morphology and number of AMRs were influenced by different stimulation and recording sites. Abnormal muscular response disappeared and hemifacial spasm was completely relieved without facial paralysis postoperatively.
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Iwami K, Watanabe T, Yokota M, Hara M, Osuka K, Miyachi S. Feasibility of underwater microvascular decompression for hemifacial spasm: a technical note. Acta Neurochir (Wien) 2021; 163:2435-2444. [PMID: 34218323 DOI: 10.1007/s00701-021-04899-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND We present a case series of underwater microvascular decompression (MVD) for hemifacial spasm (HFS) and an evaluation of its feasibility and safety. METHODS This retrospective study was conducted at a single institution and included 20 patients with HFS who underwent underwater MVD between September 2019 and January 2021. Surgery was performed in 3 steps, as follows: exoscopic wound opening (soft tissue, bone, dura, and arachnoid around the cerebellomedullary cistern), underwater endoscopic surgery (decompression of the facial nerve), and exoscopic wound closure. In underwater endoscopic surgery, the surgical field was continuously irrigated with artificial cerebrospinal fluid. Abnormal muscle response and brainstem auditory evoked potentials (BAEPs) were monitored. RESULTS Neurovascular conflicts were clearly observed in all patients without fogging and soiling of the endoscope lens. HFS was completely relieved in 19 patients (95%). An amplitude reduction of wave V of BAEPs of more than 50% was not observed in any of the cases. In 5 cases (25%), the latency of wave V of BAEPs was prolonged for more than 1.0 ms; these changes completely or near completely returned to baseline values at dural closure in all 5 cases. A postoperative complication of transient facial palsy was observed in 1 patient (5%) during postoperative days 10-30. There were no other complications. CONCLUSIONS Our findings suggest that underwater MVD is a safe and feasible option for the treatment of HFS. However, it did not show advantages over conventional endoscopic MVD when the protective effect on the eighth cranial nerve was evaluated.
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Affiliation(s)
- Kenichiro Iwami
- Department of Neurosurgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi Prefecture, 480-1195, Japan.
| | - Tadashi Watanabe
- Department of Neurosurgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi Prefecture, 480-1195, Japan
| | - Mao Yokota
- Department of Neurosurgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi Prefecture, 480-1195, Japan
| | - Masato Hara
- Department of Neurosurgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi Prefecture, 480-1195, Japan
| | - Koji Osuka
- Department of Neurosurgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi Prefecture, 480-1195, Japan
| | - Shigeru Miyachi
- Department of Neurosurgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi Prefecture, 480-1195, Japan
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Kim M, Park SK, Lee S, Lee JA, Park K. Lateral spread response of different facial muscles during microvascular decompression in hemifacial spasm. Clin Neurophysiol 2021; 132:2503-2509. [PMID: 34454279 DOI: 10.1016/j.clinph.2021.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/21/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Interpreting lateral spread response (LSR) during microvascular decompression (MVD) for hemifacial spasm (HFS) is difficult when LSRs observed in different muscles do not match. We aimed to analyze LSR patterns recorded in both the orbicularis oris (oris) and mentalis muscles and their relationships with clinical outcomes. METHODS The data of 1288 HFS patients who underwent MVD between 2015 and 2018 were retrospectively reviewed. LSR was recorded in the oris and mentalis muscles through centrifugal stimulation of the temporal branch of the facial nerve after preoperative mapping. The disappearance of LSR following surgery, clinical outcomes, and the characteristics of LSR in oris were analyzed. RESULTS After surgery, LSR remained in 100 (7.7%) and 279 (21.6%) of the mentalis and oris muscles, respectively. The postoperative outcome correlated with LSR disappearance in the mentalis, not with that in the oris. CONCLUSION LSR patterns differed in each muscle and may not be correlated with clinical outcomes. LSR in the mentalis and oris muscles should be interpreted differently. SIGNIFICANCE We describe a monitoring protocol characterized by preoperative facial nerve mapping, antidromic stimulation, and recording from multiple muscles. We analyze differences in LSRs in the mentalis and oris muscles and suggest technical points for interpretation.
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Affiliation(s)
- Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung, Republic of Korea; Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
| | - Seunghoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jeong-A Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
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Nugroho SW, Perkasa SAH, Gunawan K, Manuhutu YN, Rahman MA, Rizky A. Predicting outcome of hemifacial spasm after microvascular decompression with intraoperative monitoring: A systematic review. Heliyon 2021; 7:e06115. [PMID: 33644443 PMCID: PMC7889992 DOI: 10.1016/j.heliyon.2021.e06115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/07/2020] [Accepted: 01/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Microvascular decompression has been established as a primary treatment for hemifacial spasm. Intraoperative monitoring is used during the surgery to guide neurosurgeons to determine whether the decompression of facial nerve from the vessel is sufficient. We performed a systematic review to assess the role of lateral spread response (LSR) monitoring in predicting hemifacial spasm outcomes after microvascular decompression. METHOD A systematic search of PubMed, ScienceDirect, Cochrane, and Google Scholar was conducted. We included studies that performed microvascular decompression surgery with intraoperative monitoring analyzing the correlation between lateral spread response and spasm relief. A critical appraisal was conducted for selected studies. RESULT Twenty-two studies comprising 6404 cases of hemifacial spasm, which underwent microvascular decompression surgery with intraoperative monitoring, were included. Of 15 articles that assessed symptoms shortly after surgery, 12 studies showed a significant correlation between lateral spread response resolution and disappearance of spasm. Four of six studies that evaluated the outcome at 3-month follow-up showed significant relationship between LSR and outcome, so did five of six articles that assessed spasm relief at 6-month follow-up. As much as 62.5% of studies (10 of 16) showed the result at long-term follow-up (≥1-year) was not significant. CONCLUSION Intraoperative monitoring during microvascular decompression surgery can be a useful tool to predict hemifacial spasm resolution. Though long-term outcomes of patients with LSR relief and persistence are similar, resolution of symptoms shortly after surgery will provide comfort to patients thereby improving their quality of life.
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Affiliation(s)
- Setyo Widi Nugroho
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
| | - Sayyid Abdil Hakam Perkasa
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
| | - Kevin Gunawan
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
| | - Yovanka Naryai Manuhutu
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
| | - Muhamad Aulia Rahman
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
| | - Amal Rizky
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
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Compagnon C, Labrousse M, Brenet E, Chays A, Bazin A, Kleiber JC, Dubernard X. Efficacy and Complications of Microsurgical Neurovascular Decompression in 55 Patients With Hemifacial Spasm. Otolaryngol Head Neck Surg 2020; 164:1299-1306. [PMID: 33198570 DOI: 10.1177/0194599820969168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the efficacy and complications of microvascular decompression for hemifacial spasm. STUDY DESIGN Retrospective study. SETTING Regional hospital. METHODS Fifty-five patients with hemifacial spasm were treated by microvascular decompression. All patients with hemifacial spasm who underwent retrosigmoid microvascular decompression from May 2004 to January 2017 were included. Patients with no conflict on preoperative magnetic resonance imaging or with an alternate diagnosis were excluded. RESULTS The overall cure rate was 83.64%, with an average follow-up of 7.4 years. A left-sided hemifacial spasm was a healing-promoting factor (P = .01). The median healing was 0.03 months, and the mean was 6 months. The efficacy remained high in the medium term (88% at 3 years), long term (90.24% at 5 years), and very long term (90.48% at 8 years). The recurrence rate was 9.8%. Favorable criteria included a right-sided spasm (P = .01) and an average age of 62 years (P = .03). The specific complications were permanent facial palsy (3.63%), unilateral deafness (5.45%), and hearing loss (3.63%). No death was reported. Regarding the quality of life of the patients, 94.7% had a modified HFS-8 postoperative score of 0 (Hemifacial Spasm 8 Quality of Life Scale). CONCLUSION Microvascular decompression for hemifacial spasm is an effective and lasting technique. Its low rate of complications and the considerable quality-of-life improvement should lead surgeons to propose it to patients as soon as botulinum toxin injections become ineffective or poorly tolerated.
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Affiliation(s)
- Chloé Compagnon
- Department of Otorhinolaryngology, Head and Neck Pole, Robert Debré Hospital, Reims University Hospital, Grand Est Region, France
| | - Marc Labrousse
- Department of Otorhinolaryngology, Head and Neck Pole, Robert Debré Hospital, Reims University Hospital, Grand Est Region, France
| | - Esteban Brenet
- Department of Otorhinolaryngology, Head and Neck Pole, Robert Debré Hospital, Reims University Hospital, Grand Est Region, France
| | - André Chays
- Department of Otorhinolaryngology, Head and Neck Pole, Robert Debré Hospital, Reims University Hospital, Grand Est Region, France.,Otoneurosurgical Institute of Champagne-Ardenne, Head and Neck Department, Maison Blanche Hospital, Reims University Hospital, Grand Est Region, France
| | - Arnaud Bazin
- Otoneurosurgical Institute of Champagne-Ardenne, Head and Neck Department, Maison Blanche Hospital, Reims University Hospital, Grand Est Region, France.,Department of Neurosurgery, Head and Neck Department, Maison Blanche Hospital, Reims University Hospital, Grand Est Region, France
| | - Jean-Charles Kleiber
- Otoneurosurgical Institute of Champagne-Ardenne, Head and Neck Department, Maison Blanche Hospital, Reims University Hospital, Grand Est Region, France.,Department of Neurosurgery, Head and Neck Department, Maison Blanche Hospital, Reims University Hospital, Grand Est Region, France
| | - Xavier Dubernard
- Department of Otorhinolaryngology, Head and Neck Pole, Robert Debré Hospital, Reims University Hospital, Grand Est Region, France.,Otoneurosurgical Institute of Champagne-Ardenne, Head and Neck Department, Maison Blanche Hospital, Reims University Hospital, Grand Est Region, France
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Predictive value of intraoperative blink reflex monitoring for surgical outcome during microvascular decompression for hemifacial spasm. Clin Neurophysiol 2020; 131:2268-2275. [DOI: 10.1016/j.clinph.2020.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/21/2020] [Accepted: 06/13/2020] [Indexed: 11/17/2022]
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15
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Thirumala PD, Altibi AM, Chang R, Saca EE, Iyengar P, Reddy R, Anetakis K, Crammond DJ, Balzer JR, Sekula RF. The Utility of Intraoperative Lateral Spread Recording in Microvascular Decompression for Hemifacial Spasm: A Systematic Review and Meta-Analysis. Neurosurgery 2020; 87:E473-E484. [DOI: 10.1093/neuros/nyaa069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/30/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Microvascular decompression (MVD) is the surgical treatment of choice for hemifacial spasm (HFS). During MVD, monitoring of the abnormal lateral spread response (LSR), an evoked response to facial nerve stimulation, has been traditionally used to monitor adequacy of cranial nerve (CN) VII decompression.
OBJECTIVE
To assess the utility of LSR monitoring in predicting spasm-free status after MVD postoperatively.
METHODS
We searched PubMed, Web of Science, and Embase for relevant publications. We included studies reporting on intraoperative LSR monitoring during MVD for HFS and spasm-free status following the procedure. Sensitivity of LSR, specificity, diagnostic odds ratio, and positive predictive value were calculated.
RESULTS
From 148 studies, 26 studies with 7479 patients were ultimately included in this meta-analysis. The final intraoperative LSR status predicted the clinical outcome of MVD with the following specificities and sensitivities: 89% (0.83- 0.93) and 40% (0.30- 0.51) at discharge, 90% (0.84-0.94) and 41% (0.29-0.53) at 3 mo, 89% (0.83-0.93) and 40% (0.30-0.51) at 1 yr. When LSR persisted after MVD, the probability (95% CI) for HFS persistence was 47.8% (0.33-0.63) at discharge, 40.8% (0.23-0.61) at 3 mo, and 24.4% (0.13-0.41) at 1 yr. However, when LSR resolved, the probability for HFS persistence was 7.3% at discharge, 4.2% at 3 mo, and 4.0% at 1 yr.
CONCLUSION
Intraoperative LSR monitoring has high specificity but modest sensitivity in predicting the spasm-free status following MVD. Persistence of LSR carries high risk for immediate and long-term facial spasm persistence. Therefore, adequacy of decompression should be thoroughly investigated before closing in cases where intraoperative LSR persists.
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Affiliation(s)
- Parthasarathy D Thirumala
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ahmed M Altibi
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert Chang
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eyad E Saca
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pragnya Iyengar
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rajiv Reddy
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katherine Anetakis
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Donald J Crammond
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jeffrey R Balzer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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16
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Zhang J, Li ZH, Wang JF, Chen YH, Wang N, Wang Y. Prognostic Value of Abnormal Muscle Response During Microvascular Decompression for Hemifacial Spasm: A Meta-Analysis. World Neurosurg 2020; 137:8-17. [PMID: 32006731 DOI: 10.1016/j.wneu.2020.01.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To perform a comprehensive meta-analysis to systematically assess the value of abnormal muscle response (AMR) in predicting the surgical outcome of patients with hemifacial spasm. METHODS The electronic database PubMed, Embase, Web of Science, and ScienceDirect were searched, and relevant articles were identified up to September 30, 2019. These data were extracted for pooled analysis, heterogeneity testing, sensitivity analysis, publication bias analysis, and Fagan plot analysis. RESULTS The disappearance of AMR during microvascular decompression was associated with a favorable short-term surgical outcome (pooled relative risk [RR], 1.42; 95% confidence interval [CI], 1.24-1.62; pooled RR adjusted for publication bias, 1.30; 95% CI, 1.08-1.57). The corresponding pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.91 (95% CI, 0.88-0.94), 0.34 (95% CI, 0.27-0.42), 1.4 (95% CI, 1.2-1.6), 0.26 (95% CI, 0.17-0.38), and 5 (95% CI, 3-9), respectively. The disappearance of AMR was almost ineffective in predicting the long-term surgical outcome (pooled RR, 1.09; 95% CI, 1.02-1.17; pooled RR adjusted for publication bias, 1.001; 95% CI, 0.92-1.09). The corresponding pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.90 (95% CI, 0.85-0.93), 0.28 (95% CI, 0.20-0.37), 1.2 (95% CI, 1.1-1.4), 0.38 (95% CI, 0.22-0.63), and 3 (95% CI, 2-6), respectively. CONCLUSIONS The disappearance of AMR during microvascular decompression demonstrates limited prognostic value for a favorable short-term outcome, and does not appear effective in predicting the long-term outcome of patients with hemifacial spasm.
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Affiliation(s)
- Jie Zhang
- Department of Neuroelectrophysiology, Cangzhou Central Hospital, Yunhe District, Cangzhou, Hebei, People's Republic of China
| | - Zong-Hao Li
- Department of Neurosurgery, Cangzhou Central Hospital, Yunhe District, Cangzhou, Hebei, People's Republic of China.
| | - Jin-Feng Wang
- Department of Neuroelectrophysiology, Cangzhou Central Hospital, Yunhe District, Cangzhou, Hebei, People's Republic of China
| | - Yong-Han Chen
- Department of Neurosurgery, Cangzhou Central Hospital, Yunhe District, Cangzhou, Hebei, People's Republic of China
| | - Ning Wang
- Department of Neuroelectrophysiology, Cangzhou Central Hospital, Yunhe District, Cangzhou, Hebei, People's Republic of China
| | - Yi Wang
- Department of Neurosurgery, Cangzhou Central Hospital, Yunhe District, Cangzhou, Hebei, People's Republic of China
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17
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El Refaee E, Marx S, Rosenstengel C, Baldauf J, Schroeder HWS. Arachnoid bands and venous compression as rare causes of hemifacial spasm: analysis of etiology in 353 patients. Acta Neurochir (Wien) 2020; 162:211-219. [PMID: 31754846 DOI: 10.1007/s00701-019-04119-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemifacial spasm is usually caused by arterial compression at the root exit zone of the facial nerve. However, other etiologies have been reported. The aim of this study was to analyze the frequency of other causes of hemifacial spasm. METHODS Our prospectively maintained hemifacial spasm database containing all patients who underwent microvascular decompression (MVD) for hemifacial spasm from 2002 to 2018 was reviewed. All offending structures were identified and recorded by the surgeon at the time of surgery. Additionally, the operative videos were analyzed retrospectively. RESULTS MVD was performed in 353 patients. Arterial compression was the main cause of hemifacial spasm in 341 (96.9%) patients. Combined venous-arterial compression was seen in 7 (2.0%) patients. In one patient, the compression was from a large vein. In two patients, no compression was found. One patient who suffered from Bell's palsy many years previously had severe synkinesis and the other had facial tics. In two patients, the spasm was caused due to strangulation of the facial nerve by arachnoid bands. Long-term follow-up of more than 18 months was available in 249 patients with total resolution or near total resolution of spasms in 89.96% of patients. CONCLUSIONS In most patients with hemifacial spasm, arterial vessels are involved in compressing the facial nerve. Purely venous compression is rarely encountered. We report for the very first time arachnoid bands strangulating the nerve as a cause for hemifacial spasm without involvement of any vessel.
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Affiliation(s)
- Ehab El Refaee
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany.
- Department of Neurosurgery, Cairo University, Cairo, Egypt.
| | - Sascha Marx
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Christian Rosenstengel
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Joerg Baldauf
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Henry W S Schroeder
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
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18
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Flanders TM, Blue R, Roberts S, McShane BJ, Wilent B, Tambi V, Petrov D, Lee JYK. Fully endoscopic microvascular decompression for hemifacial spasm. J Neurosurg 2019; 131:813-819. [PMID: 30497190 DOI: 10.3171/2018.4.jns172631] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hemifacial spasm (HFS) is characterized by involuntary tonic and/or clonic contractions of facial nerve muscles. Fully endoscopic microvascular decompression (E-MVD) for HFS has not been widely adopted. This paper aims to illustrate the safety and efficacy of the fully endoscopic technique for HFS treatment. METHODS The authors conducted a single-center retrospective study of 27 patients (28 separate E-MVD cases; 1 patient had bilateral E-MVD) diagnosed with HFS who underwent fully E-MVD from January 2013 to October 2016. Intraoperative brainstem auditory evoked potentials and lateral spread resolution were reviewed. Outcome was based on the clinical status of the patient at the last contact point with the senior author. Complications were categorized as facial weakness, hearing loss, ataxia, dysphagia, or any adverse event able to be attributed to the surgical procedure. RESULTS HFS was relieved either completely or partially in the majority of cases (24 of 28, 85.7%). Of the 28 separate procedures, 17 (60.7%) resulted in complete resolution of symptoms, 4 (14.3%) resulted in near-complete resolution, 2 (7.1%) resulted in 50% reduction of symptoms, 1 (3.6%) resulted in minimal reduction, and 4 (14.3%) resulted in no relief. Of the 27 patients, 26 (96%) had no permanent postoperative complications. In multivariate logistic regression, the best predictor of greater than 50% resolution of spasm was resolution of intraoperative lateral spread response. CONCLUSIONS A fully E-MVD for HFS provides a safe and comprehensive view of the neurovascular conflict. Exclusive use of the endoscope in MVD is both safe and feasible in the treatment of HFS. Attention to lateral spread response monitoring remains an integral part of comprehensive neurosurgical management.
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Affiliation(s)
- Tracy M Flanders
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Rachel Blue
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Sanford Roberts
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Brendan J McShane
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | | | | | - Dmitriy Petrov
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - John Y K Lee
- 1Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and
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19
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Baldauf J, Rosenstengel C, Schroeder HWS. Nerve Compression Syndromes in the Posterior Cranial Fossa. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:54-60. [PMID: 30855007 DOI: 10.3238/arztebl.2019.0054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 03/29/2018] [Accepted: 10/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nerve compression syndromes in the posterior cranial fossa can severely impair patients' quality of life. There is often uncertainty about the best treatment. In this article, we provide an overview of these conditions and the corresponding treatment strategies. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and on a scientific analysis of the authors' patient collective. RESULTS These syndromes are caused by compression of a cranial nerve by an artery or vein at the zone of the nerve's entry to or exit from the brainstem. The best-known neurovascular compression syndrome is trigeminal neuralgia, followed by hemifacial spasm. Less well known are glossopharyngeal neuralgia, nervus intermedius neuralgia, and vestibular paroxysmia. The initial treatment of trigeminal neuralgia is medical: the first line of treatment is with sodium-blocking anticon- vulsants, such as carbamazepine. For patients with hemifacial spasm, botulinum toxin injection is the recommended initial treatment and often leads to a satisfactory regression of the spasms. If these treatments fail, a microvascular decompression operation is indicated. The aim of the procedure is to separate the irritating vessel from the nerve and to keep these structures apart permanently. There is hardly any available evidence on these treatment strategies from randomized controlled trials. CONCLUSION Nerve compression syndromes in the posterior cranial fossa can generally be treated nonsurgically at first. Over the course of the condition, however, treatment failure or intolerable side effects may arise. In such cases, a microvascu- lar decompression operation is indicated. This is a causally directed form of treat- ment that generally yields very good results.
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Affiliation(s)
- Jörg Baldauf
- Department of Neurosurgery, University Medicine Greifswald
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20
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Shu W, Zhu H, Li Y, Liu R. Clinical analysis of repeat microvascular decompression for recurrent hemifacial spasm. Acta Neurol Belg 2019; 119:453-459. [PMID: 30963475 DOI: 10.1007/s13760-019-01103-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
The aim of this study was to investigate the effects of repeat microvascular decompression (MVD) for recurrent hemifacial spasm (HFS). The clinical features, surgical findings, outcomes, and complications of 13 patients who underwent MVD with a history of prior MVD in Xuanwu Hospital between January 2010 and May 2017 were analysed retrospectively. All patients were successfully treated for their HFS but experienced recurrent symptoms and received repeat MVD. Teflon felt factors (9/13, 69.2%) and vascular changes (4/13, 30.8%) were the main reasons for recurrent HFS. With a mean follow-up of 34.6 months after surgery (ranging from 12 to 92 months), 11 (84.6%) patients achieved complete or major spasm alleviation and two patients (15.4%) achieved fair outcomes. Surgical complications included transited mild to moderate facial weakness in two patients (15.4%). None of the patients had serious surgical morbidities. Repeat MVD is an effective and safe treatment for recurrent HFS.
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Song H, Xu S, Fan X, Yu M, Feng J, Sun L. Prognostic value of lateral spread response during microvascular decompression for hemifacial spasm. J Int Med Res 2019; 47:6120-6128. [PMID: 30982379 PMCID: PMC7045667 DOI: 10.1177/0300060519839526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
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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Affiliation(s)
- Hongmei Song
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Songbai Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiushuang Fan
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Mingxin Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jiachun Feng
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lichao Sun
- Department of Emergency Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
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A Rare Potential Compression Can Be Avoided by Lateral Spread Response Recordings During Microvascular Decompression for Hemifacial Spasm. J Craniofac Surg 2019; 30:e501-e503. [PMID: 30921064 DOI: 10.1097/scs.0000000000005400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The authors report a 34-year-old female with hemifacial spasm who was identified as a candidate for microvascular decompression. Lateral spread response (LSR) was not recorded at first because of anatomical shift of neurovascular relationship after drainage of cerebrospinal fluid, but they reappeared only after a piece of shredded gelatin sponge was placed near the posteroinferior cerebellar artery to expand surgical field. As the authors removed the gelatin sponge, the LSRs disappeared instantly. Subsequently, the authors put some soft shredded Teflon between the offending vessel and brainstem. Since then the authors did not find LSRs anymore. Clinical follow-up had been carried out with a questionnaire from 1 week to 3 months postoperatively, and the patient was cured with no complications. This report presented that the gelatin sponge placed in an inappropriate position resulting in compression potentially leading to the opposite effect of treatment. Such kind of excessive operation could be avoided by electrophysiological monitoring.
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Endoscope-Assisted Microvascular Decompression for the Management of Hemifacial Spasm Caused by Vertebrobasilar Dolichoectasia. World Neurosurg 2019; 121:e566-e575. [DOI: 10.1016/j.wneu.2018.09.166] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/21/2022]
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Lefaucheur JP. New insights into the pathophysiology of primary hemifacial spasm. Neurochirurgie 2018; 64:87-93. [DOI: 10.1016/j.neuchi.2017.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 12/21/2022]
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25
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Ghali MGZ, Srinivasan VM, Viswanathan A. Microvascular Decompression for Hemifacial Spasm. Int Ophthalmol Clin 2018; 58:111-121. [PMID: 29239883 DOI: 10.1097/iio.0000000000000209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Abstract
OPINION STATEMENT The treatment of both hemifacial spasm (HFS) and blepharospasm (BEB) requires making the appropriate clinical diagnosis. Advance imaging and electrophysiologic studies are useful; however, one's clinical suspicion is paramount. The purpose of this review is to summarize current and emerging therapies for both entities. Botulinum toxin (BTX) remains the first-line therapy to treat both conditions. If chemodenervation has failed, surgery may be considered. Due to the risks associated with surgery, the benefits of this option must be carefully weighed. Better surgical outcomes are possible when procedures are performed at tertiary centers with experienced surgeons and advanced imaging techniques. Microvascular decompression is an efficacious method to treat HFS, and myectomy is an option for medication-refractory BEB; the risks of the latter may outweigh any meaningful clinical benefits. Oral agents only provide short-term relief and can cause several unwanted effects; they are reserved for patients who cannot receive BTX and/or surgery. Transcranial magnetic stimulation has gained some traction in the treatment of BEB and may provide safer non-invasive options for refractory patients in the future.
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Affiliation(s)
- Kemar E Green
- Departments of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA.
| | - David Rastall
- Michigan State University, College of Osteopathic Medicine, East Lansing, MI, USA
| | - Eric Eggenberger
- Departments of Ophthalmology and Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
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