Predicting outcome of hemifacial spasm after microvascular decompression with intraoperative monitoring: A systematic review

Abstract

Background: Microvascular decompression has been established as a primary treatment for hemifacial spasm. Intraoperative monitoring is used during the surgery to guide neurosurgeons to determine whether the decompression of facial nerve from the vessel is sufficient. We performed a systematic review to assess the role of lateral spread response (LSR) monitoring in predicting hemifacial spasm outcomes after microvascular decompression.

Method: A systematic search of PubMed, ScienceDirect, Cochrane, and Google Scholar was conducted. We included studies that performed microvascular decompression surgery with intraoperative monitoring analyzing the correlation between lateral spread response and spasm relief. A critical appraisal was conducted for selected studies.

Result: Twenty-two studies comprising 6404 cases of hemifacial spasm, which underwent microvascular decompression surgery with intraoperative monitoring, were included. Of 15 articles that assessed symptoms shortly after surgery, 12 studies showed a significant correlation between lateral spread response resolution and disappearance of spasm. Four of six studies that evaluated the outcome at 3-month follow-up showed significant relationship between LSR and outcome, so did five of six articles that assessed spasm relief at 6-month follow-up. As much as 62.5% of studies (10 of 16) showed the result at long-term follow-up (≥1-year) was not significant.

Conclusion: Intraoperative monitoring during microvascular decompression surgery can be a useful tool to predict hemifacial spasm resolution. Though long-term outcomes of patients with LSR relief and persistence are similar, resolution of symptoms shortly after surgery will provide comfort to patients thereby improving their quality of life.

Keywords: Abnormal muscle response; Hemifacial spasm; Intraoperative monitoring; Lateral spread response; Microvascular decompression.

Figure 1

Facial nerve course of motor, sensory, parasympathetic innervation.

Figure 2

Change of LSR during MVD. Intraoperative monitoring depicting partial resolution of LSR (left), gradually disappearing completely after vascular detachment and Teflon insertion (right).

Figure 3

Flowchart of screening strategy for included studies.