A reappraisal of the value of lateral spread response monitoring in the treatment of hemifacial spasm by microvascular decompression.
BACKGROUND
Lateral spread response (LSR) to the electrical stimulation of a facial nerve branch is a specific electrophysiological feature of primary hemifacial spasm (HFS). The curative treatment of HFS is based on surgical microvascular decompression (MVD). However, the outcome of this procedure is not always satisfactory.


OBJECTIVE
To evaluate the correlation between intraoperative LSR changes and the short- and long-term postoperative clinical outcome following MVD.


METHODS
Thirty-two consecutive patients with primary HFS treated by MVD performed with intraoperative LSR monitoring were retrospectively included. The patients were assessed for the presence of HFS and surgical complications at 1 day, 1 month and 6 months after surgery. The long-term clinical result was assessed between 1 and 10 years (mean 5.4 years) using a self-report questionnaire.


RESULTS
Patients were divided into three groups based on intraoperative LSR changes: (1) in 15 patients, LSRs were present before incision and disappeared after MVD (47%); (2) in nine patients, LSRs were present before incision but persisted despite MVD (28%); (3) in eight patients, LSRs were absent before surgery and remained so after the procedure (25%). Intraoperative LSR abolition during the MVD procedure correlated with HFS relief in the long term (p<0.0001, Fisher exact test), but not on the first day after surgery (p = 0.3564).


CONCLUSIONS
Monitoring MVD by recording LSRs intraoperatively could be of value not only to indicate the resolution of the vasculonervous conflict at the end of surgery, but also to predict a successful clinical outcome in the long term after the surgical intervention.
Neves
D O
DO
Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Universit Paris XII, Créteil, France.
Lefaucheur
J-P
JP
de Andrade
D Ciampi
DC
Hattou
M
M
Ahdab
R
R
Ayache
S S
SS
Le Guerinel
C
C
Keravel
Y
Y
D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D004576:Electromyography; D005152:Facial Muscles / Q000503:physiopathology; D005260:Female; D019569:Hemifacial Spasm / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery; D055806:Microvessels / Q000601:surgery*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies; D016896:Treatment Outcome