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The value of lateral spread response monitoring in predicting the clinical outcome after microvascular decompression in hemifacial spasm: a prospective study on 100 patients

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Abstract

Microvascular decompression represents an effective treatment for hemifacial spasm. The use of lateral spread response (LSR) monitoring remains a useful intraoperative tool to ensure adequate decompression of the facial nerve. The aim of this study was to assess the value of LSRs intraoperative monitoring as a prognostic indicator for the outcome of microvascular decompression in hemifacial spasm. Our study included 100 patients prospectively. The patients were classified into four groups whether LSRs were totally, partially, not relieved, or not detected from the start. According to clinical outcome, the patients were classified into four groups depending on the clinical course after surgery and the residual symptoms if any. Then, correlations were made between LSR events and treatment outcome to detect its reliability as a prognostic indicator. LSRs were relieved totally in 56 % of the patients, partially relieved in 14 %, not relieved in 10 %, and were not detected in 20 % of the patients from the start. HFS was relieved directly after operation in 62 % with clinical improvement of 90–100 %. Thirty-one percent described 50–90 % improvement over the next 3 months after surgery. Almost all of these 31 % (28 out of 31 patients) reported further clinical improvement of 90–100 % within 1 year after surgery. Three percent suffered from a relapse after a HFS-free period, and 4 % reported minimal or no improvement describing 0–50 % of the preoperative state. The percentage of the satisfied patients with the clinical outcome who reported after 1 year a clinical improvement of 90–100 % was 90 %. Statistical analysis did not find a significant correlation between the relief of LSRs and clinical outcome. LSRs may only represent an intraoperative tool to guide for an adequate decompression but failed to represent a reliable prognostic indicator for treatment outcome.

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Acknowledgments

We would like to thank Mrs. Angelika Pieper for her help in the preparation of this work.

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Author notes

  1. Ahmed El Damaty

    Present address: Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany

Authors and Affiliations

  1. Department of Neurosurgery, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt

    Ahmed El Damaty

  2. Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany

    Christian Rosenstengel, Marc Matthes, Joerg Baldauf & Henry W. S. Schroeder

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  1. Ahmed El Damaty
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  2. Christian Rosenstengel
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Corresponding author

Correspondence to Ahmed El Damaty.

Ethics declarations

The local ethics committee approved this prospective study.

Financial support

Ahmed El Damaty has received a DAAD research scholarship to support his study. Henry W. S. Schroeder is a consultant to Karl Storz GmbH & Co. KG, Tuttlingen, Germany.

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Comments

Kwan Park and Doo-Sik Kong, Seoul, Korea

This prospective study is regarding the efficacy of lateral spread response (LSR) monitoring during microvascular decompression (MVD) surgery for hemifacial spasm. In this study, the efficacy of LSR during MVD is a very interesting issue, but still under debate. When monitoring during MVD, we sometimes experience the phenomenon of disappearance of LSR only after opening the dura and drainage of cerebrospinal fluid (CSF). This finding must be a very confusing event for a surgeon. Accordingly, it is very important to compare LSR response between before and after the insertion of Teflon. Also, we need highly sophisticated and dedicated monitoring team and systems to confirm adequate decompression during MVD.

The authors performed endoscope-assisted MVD in this study. It is well-known that endoscope-assisted surgery can provide a panoramic surgical view and helpful confirmation of adequate decompression. However, to draw a conclusion of substantial benefit from the endoscope-assisted MVD, additional validation and research would be necessary.

This study reinforces the reader’s knowledge about the various complications of MVD. We should keep in mind that herpes infection-associated meningitis can be a possible cause of death after MVD, because reactivation of Herpes labialis has a very common incidence after cranial nerve surgery including MVD.

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El Damaty, A., Rosenstengel, C., Matthes, M. et al. The value of lateral spread response monitoring in predicting the clinical outcome after microvascular decompression in hemifacial spasm: a prospective study on 100 patients. Neurosurg Rev 39, 455–466 (2016). https://doi.org/10.1007/s10143-016-0708-9

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  • DOI: https://doi.org/10.1007/s10143-016-0708-9

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