title: Microvascular decompression for hemifacial spasm: evaluating outcome prognosticators including the value of intraoperative lateral spread response monitoring and clinical characteristics in 293 patients.
abstract: Hemifacial spasm is a socially disabling condition that manifests as intermittent involuntary twitching of the eyelid and progresses to muscle contractions of the entire hemiface. Patients receiving microvascular decompression of the facial nerve demonstrate an abnormal lateral spread response (LSR) in peripheral branches during facial electromyography. The authors retrospectively evaluate the prognostic value of preoperative clinical characteristics and the efficacy of intraoperative monitoring in predicting short- and long-term relief after microvascular decompression for hemifacial spasm. Microvascular decompression was performed in 293 patients with hemifacial spasm, and LSR was recorded during intraoperative facial electromyography monitoring. In 259 (87.7%) of the 293 patients, the LSR was attainable. Patient outcome was evaluated on the basis of whether the LSR disappeared or persisted after decompression. The mean follow-up period was 54.5 months (range, 9-102 months). A total of 88.0% of patients experienced immediate postoperative relief of spasm; 90.8% had relief at discharge, and 92.3% had relief at follow-up. Preoperative facial weakness and platysmal spasm correlated with persistent postoperative spasm, with similar trends at follow-up. In 207 patients, the LSR disappeared intraoperatively after decompression (group I), and in the remaining 52 patients, the LSR persisted intraoperatively despite decompression (group II). There was a significant difference in spasm relief between both groups within 24 hours of surgery (94.7% vs. 67.3%) (P < 0.0001) and at discharge (94.2% vs. 76.9%) (P = 0.001), but not at follow-up (93.3% vs. 94.4%) (P = 1.000). Multivariate logistic regression analysis demonstrated independent predictability of residual LSR for present spasm within 24 hours of surgery and at discharge but not at follow-up. Facial electromyography monitoring of the LSR during microvascular decompression is an effective tool in ensuring a complete decompression with long-lasting effects. Although LSR results predict short-term outcomes, long-term outcomes are not as reliant on LSR activity.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA. thirumalapd@upmc.edu
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
authors.forename: Aalap C
authors.initials: AC
authors.lastname: Shah
authors.forename: Tara N
authors.initials: TN
authors.lastname: Nikonow
authors.forename: Miguel E
authors.initials: ME
authors.lastname: Habeych
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Balzer
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Crammond
authors.forename: Lois
authors.initials: L
authors.lastname: Burkhart
authors.forename: Yue-Fang
authors.initials: YF
authors.lastname: Chang
authors.forename: Paul
authors.initials: P
authors.lastname: Gardner
authors.forename: Amin B
authors.initials: AB
authors.lastname: Kassam
authors.forename: Michael B
authors.initials: MB
authors.lastname: Horowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013181:Cortical Spreading Depression / Q000502:physiology*; D004576:Electromyography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D019569:Hemifacial Spasm / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D061145:Microvascular Decompression Surgery / Q000379:methods*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult