Prognostic value of the lateral spread response for intraoperative electromyography monitoring of the facial musculature during microvascular decompression for hemifacial spasm

Doo-Sik Kong M.D., Kwan Park M.D., Ph.D., Byoung-gook Shin M.D., Jeong Ah Lee R.N., M.S., and Dong-Ok Eum B.S.
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  • Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Object

The authors conducted a large retrospective study in which they evaluated the efficacy of intraoperative electromyography (EMG) monitoring of facial musculature during microvascular decompression (MVD) and assessed the predictive value of the lateral spread response (LSR) as a prognostic indicator for the treatment outcome of hemifacial spasm (HFS).

Methods

The authors undertook intraoperative monitoring during MVD in 300 consecutive patients with HFS. The patients were divided into two groups based on whether the LSR disappeared or persisted following decompression. The mean follow-up period was 35.8 months (range 12–55 months). In 263 (87.7%) of the 300 patients, the LSR was observed during intraoperative facial EMG monitoring. In 230 (87.4%) of these 263 patients, the LSR disappeared following decompression (Group I), and in the remaining 33 patients (12.5%) the LSR persisted despite decompression (Group II). At the postoperative 1-year follow-up visit, there was a significant difference in clinical outcomes between both groups (p < 0.05).

Conclusions

Facial EMG monitoring of the LSR is an effective tool to use when performing complete decompression, and it may be helpful in predicting outcomes.

Abbreviations used in this paper:EMG = electromyography; HFS = hemifacial spasm; LSR = lateral spread response; MVD = microvascular decompression.

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Contributor Notes

Address reprint requests to: Kwan Park, M.D., Ph.D., Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 50 Ilwon-dong, Kangnamgu, Seoul 135-710, South Korea. email: kwanpark@smc.samsung.co.kr.
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