The Effects of Dual Abnormal Muscle Response Monitoring on Microvascular Decompression in Patients with Hemifacial Spasm.
BACKGROUND
Microvascular decompression (MVD) is the most useful treatment for hemifacial spasm (HFS). During MVD surgery, traditional abnormal muscle response (tAMR) is widely used to monitor success in decompressing the facial nerve. Dual AMR (dAMR) is a new monitoring method used during MVD for HFS. We compared the sensitivities and reliabilities of tAMR and dAMR.


METHODS
We performed a retrospective study of 1301 cases of HFS treated using MVD between January 2014 and March 2016. Among the 1301 cases, 587 patients underwent tAMR monitoring and 714 underwent dAMR monitoring.


RESULTS
Typical abnormal muscle response (AMR) waveforms were observed in 484 patients (82.5%) in the tAMR group and in 688 patients (96.4%) in the dAMR group (P < 0.05). AMR waveforms disappeared in 459 patients in the tAMR group and in 655 patients in the dAMR group during MVD. One day, 7 days, 1 month, and 3 months after MVD surgeries with AMR disappearance, the effective rate of MVD was 95.0%, 94.3%, 94.5%, and 95.0%, respectively, in the tAMR group. The corresponding rates were 97.7%, 96.9%, 97.3%, and 98.0% in the dAMR group (P < 0.05). One day, 7 days, 1 month, and 3 months after MVD surgeries with AMR persistence, the effective rate of MVD was 68.0%, 64.0%, 64.0%, and 64.0%, respectively, in the tAMR group. The corresponding rates were 90.9%, 87.9%, 87.9%, and 90.9% in the dAMR group (P < 0.05).


CONCLUSIONS
AMR monitoring provides valuable neurosurgical guidance during MVD for HFS. dAMR monitoring has better sensitivity and reliability than tAMR monitoring.
Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China.
Xin
X
Zhang
Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China.
Hua
H
Zhao
Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China.
Ting-Ting
TT
Ying
Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China.
Yin-Da
YD
Tang
Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China.
Jin
J
Zhu
Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China. Electronic address: xinhuaneuro@126.com.
Shi-Ting
ST
Li
D004558:Electric Stimulation; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D019569:Hemifacial Spasm / Q000601:surgery*; D006801:Humans; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009135:Muscular Diseases / Q000209:etiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
AMR; Abnormal muscle response; HFS; Hemifacial spasm; MVD