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      Intraoperative Neurophysiological Monitoring during Microvascular Decompression Surgery for Hemifacial Spasm

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          Abstract

          Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.

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          Microvascular decompression for hemifacial spasm.

          E-h Jho, Peter J. Jannetta, M Larkins … (1995)
          The authors report the results of 782 microvascular decompression procedures for hemifacial spasm in 703 patients (705 sides), with follow-up study from 1 to 20 years (mean 8 years). Of 648 patients who had not undergone prior intracranial procedures for hemifacial spasm, 65% were women; their mean age was 52 years, and the mean preoperative duration of symptoms was 7 years. The onset of symptoms was typical in 92% and atypical in 8%. An additional 57 patients who had undergone prior microvascular decompression elsewhere were analyzed as a separate group. Patients were followed prospectively with annual questionnaires. Kaplan-Meier methods showed that among patients without prior microvascular decompression elsewhere, 84% had excellent results and 7% had partial success 10 years postoperatively. Subgroup analyses (Cox proportional hazards model) showed that men had better results than women, and patients with typical onset of symptoms had better results than those with atypical onset. Nearly all failures occurred within 24 months of operation; 9% of patients underwent reoperation for recurrent symptoms. Second microvascular decompression procedures were less successful, whether the first procedure was performed at Presbyterian-University Hospital or elsewhere, unless the procedure was performed within 30 days after the first microvascular decompression. Patient age, side and preoperative duration of symptoms, history of Bell's palsy, preoperative presence of facial weakness or synkinesis, and implant material used had no influence on postoperative results. Complications after the first microvascular decompression for hemifacial spasm included ipsilateral deaf ear in 2.6% and ipsilateral permanent, severe facial weakness in 0.9% of patients. Complications were more frequent in reoperated patients. In all, one operative death (0.1%) and two brainstem infarctions (0.3%) occurred. Microvascular decompression is a safe and definitive treatment for hemifacial spasm with proven long-term efficacy.
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            Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery.

            J Romstöck, R Fahlbusch, Adam Strauss (2000)
            Electromyography (EMG) monitoring is expected to reduce the incidence of motor cranial nerve deficits in cerebellopontine angle surgery. The aim of this study was to provide a detailed analysis of intraoperative EMG phenomena with respect to their surgical significance. Using a system that continuously records facial and lower cranial nerve EMG signals during the entire operative procedure, the authors examined 30 patients undergoing surgery on acoustic neuroma (24 patients) or meningioma (six patients). Free-running EMG signals were recorded from muscles targeted by the facial, trigeminal, and lower cranial nerves, and were analyzed off-line with respect to waveform characteristics, frequencies, and amplitudes. Intraoperative measurements were correlated with typical surgical maneuvers and postoperative outcomes. Characteristic EMG discharges were obtained: spikes and bursts were recorded immediately following the direct manipulation of a dissecting instrument near the cranial nerve, but also during periods when the nerve had not yet been exposed. Bursts could be precisely attributed to contact activity. Three distinct types of trains were identified: A, B, and C trains. Whereas B and C trains are irrelevant with respect to postoperative outcome, the A train--a sinusoidal, symmetrical sequence of high-frequency and low-amplitude signals--was observed in 19 patients and could be well correlated with additional postoperative facial nerve paresis (in 18 patients). It could be demonstrated that the occurrence of A trains is a highly reliable predictor for postoperative facial palsy. Although some degree of functional worsening is to be expected postoperatively, there is a good chance of avoiding major deficits by warning the surgeon early. Continuous EMG monitoring is superior to electrical nerve stimulation or acoustic loudspeaker monitoring alone. The detailed analysis of EMG-waveform characteristics is able to provide more accurate warning criteria during surgery.
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              Microvascular decompression for treating hemifacial spasm: lessons learned from a prospective study of 1,174 operations.

              Seung-Joo Hyun, So Park, Doo Kong (2010)
              The authors critically analyzed a large series of patients with hemifacial spasm (HFS) and who underwent microvascular decompression (MVD) under a prospective protocol. We describe several "lessons learned" that are required for achieving successful surgery and proper postoperative management. The purpose of this study is to report on our experience during the previous 10 years with this procedure and we also discuss various related topics. From April 1997 to June 2009, over 1,200 consecutive patients underwent MVD for HFS. Among them, 1,174 patients who underwent MVD for HFS with a minimum 1 year follow-up were enrolled in the study. The median follow-up period was 3.5 years (range, 1-9.3 years). Based on the operative and medical records, the intraoperative findings and the postoperative outcomes were obtained and then analyzed. At the 1-year follow-up examination, 1,105 (94.1%) patients of the total 1,174 patients exhibited a "cured" state, and 69 (5.9%) patients had residual spasms. In all the patients, the major postoperative complications included transient hearing loss in 31 (2.6%), permanent hearing loss in 13 (1.1%), transient facial weakness in 86 (7.3%), permanent facial weakness in 9 (0.7%), cerebrospinal fluid leak in three (0.25%) and cerebellar infarction or hemorrhage in two (0.17%). There were no operative deaths. Microvascular decompression is a very effective, safe modality of treatment for hemifacial spasm. MVD is not sophisticated surgery, but having a basic understanding of the surgical procedures is required to achieve successful surgery.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Korean Neurosurg Soc
                Journal ID (iso-abbrev): J Korean Neurosurg Soc
                Journal ID (publisher-id): JKNS
                Title: Journal of Korean Neurosurgical Society
                Publisher: Korean Neurosurgical Society
                ISSN (Print): 2005-3711
                ISSN (Electronic): 1598-7876
                Publication date (Print): July 2019
                Publication date (Electronic): 1 July 2019
                Volume: 62
                Issue: 4
                Pages: 367-375
                Affiliations
                [1 ]Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
                [2 ]Department of Neurology, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea
                [3 ]Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
                Author notes
                Address for reprints : Kwan Park Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel : +82-2-3410-3499, Fax : +82-2-3410-0048, E-mail : kwanmd.park@ 123456samsung.com
                Author information
                http://orcid.org/0000-0002-3263-6594
                Article
                Publisher ID: jkns-2018-0218
                DOI: 10.3340/jkns.2018.0218
                PMC ID: 6616990
                PubMed ID: 31290293
                SO-VID: 9af587db-d607-4077-9443-efaa35a0f564
                Copyright © Copyright © 2019 The Korean Neurosurgical Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 27 November 2018
                Date revision received : 20 March 2019
                Date accepted : 4 April 2019
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Surgery
                Keywords: hemifacial spasm,microvascular decompression surgery,intraoperative neurophysiological monitoring
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: hemifacial spasm, microvascular decompression surgery, intraoperative neurophysiological monitoring

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