The significance of intraoperative electromyographic "lateral spread" in predicting outcome of microvascular decompression for hemifacial spasm

Abstract

Objectives: During microvascular decompression (MVD) of the facial nerve for hemifacial spasm (HFS), an abnormal muscle response can be recorded upon stimulation of the facial nerve, also known as the lateral spread response. This response may vanish after MVD and has been associated with a successful outcome. The purpose of this study was to determine if resolution of lateral spread correlated with the elimination of HFS in a single surgeon's experience. Design and

Setting: (1) Retrospective analysis of 38 patients undergoing MVD with intraoperative electromyography for HFS. (2) Meta-analysis of studies from the literature.

Main outcome measure: Presence or absence of HFS and any complications.

Results: Lateral spread response was seen in 36 patients; 20 patients had full resolution. Of these, 15 patients became HFS free, and 5 five patients still had some degree of HFS. Sixteen patients had a persistent lateral spread response despite a technically successful MVD; 11 of these became spasm free, and 5 still suffered from some degree of facial twitching. Analyzing 16 studies reporting a total of 1301 patients, a significant correlation (p < 0.0001) between response cessation and resolution of HFS was found.

Conclusion: The role of monitoring lateral spread response as a predictor for clinical outcome is limited.

Keywords: hemifacial spasm; intraoperative monitoring; lateral spread response; microvascular decompression.

Fig. 1

Axial magnetic resonance imaging fast imaging employing steady state acquisition image of the posterior fossa in a patient with left hemifacial spasm showing typical compression of the left facial nerve at the brainstem by the ipsilateral anterior inferior cerebellar artery (white arrow).

Fig. 2

Electromyographic (EMG) recording of the lateral spread response (LSR) in microvascular decompression for hemifacial spams. Position of facial stimulation and recording electrodes (left) and typical recording with resolution of LSR after decompression (right). BAER, Brainstem Auditory Evoked Response.