Acta Neurochirurgica

, Volume 147, Issue 10, pp 1019–1026 | Cite as

Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring

  • M. P. Sindou
Review Article


There is considerable evidence that primary Hemi-Facial Spasm (HFS) is in almost all cases related to a vascular compression of the facial nerve at its Root Exit Zone (REZ) from brainstem, and that Micro-Vascular Decompression (MVD) constitutes its curative treatment. Clinical as well as electrophysiological features plead for mechanisms of the disease in structural lesions at the neural fibers (putatively: focal demyelination at origin of ephapses) and functional changes in the nuclear cells (hyperactivity of the facial nucleus).

Lateral Spread Responses (LSRs) elicited by stimulation of the facial nerve branches testify of these electrophysiological perturbations. Monitoring LSRs during surgery is feasible; however the practical value of their intraoperative disappearance as control-test of an effective decompression remains controversial.

MVD allows cure of the disease in most cases. Because the VIIIth nerve is at risk during surgery, intraoperative monitoring of Brainstem Auditory Evoked Potentials (BEAPs) is of value to reduce occurrence of hearing loss. Increase in latency of Peak V and decrease in amplitude of Peak I are warning-signals of an excessive stretching of the the cochlear nerve and impairment of the cochlear vascular supply, respectively.

Keywords: Hemifacial spasm; cranial nerve compression syndrome; microvascular decompression; intraoperative brainstem auditory evoked potentials; intraoperative EMG recordings. 


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  1. Barker, FG,II, Jannetta, PJ, Bissonette, DJ, Shields, PT, Larkins, MV, Jho, HD 1995Microvascular decompression for hemifacial spasm.J Neurosurg82201210PubMedGoogle Scholar
  2. Chun, IH, IH-Hsing, L, Liang-Shong, L 1992Microvascular decompression for hemifacial spasm: analyses of operative findings and results in 310 patients.Neurosurgery305357PubMedGoogle Scholar
  3. Esteban, A, Molina-Negro, P 1986Primary hemifacial spasm: a neurophysiological study.Neurol Neurosurg Psychiat495863Google Scholar
  4. Gardner, WJ 1966Crosstalk. The paradoxical transmission of a nerve impulse.Arch Neurol14149156PubMedGoogle Scholar
  5. Gardner, WS, Sava, GA 1962Hemifacial spasm – a reversible pathophysiologic state.J Neurosurg19240247Google Scholar
  6. Goto, Y, Matsushima, T, Natori, Y, Inamura, T, Tobimatsu, S 2002Delayed effects of the microvascular decompression on hemifacial spasm: a retrospective study of 131 consecutive operated cases.Neurol Res24296300CrossRefPubMedGoogle Scholar
  7. Granit, R, Leksell, L, Skoglund, CR 1994Fibre interaction in injured or compressed region of nerve.Brain67125140Google Scholar
  8. Grundy, BL, Jannetta, PJ, Procopio, PT, Lina, A, Boston, JR, Doyle, E 1982Intraoperative monitoring of brainstem auditory evoked potentials.J Neurosurg57674681PubMedGoogle Scholar
  9. Haines, SJ, Torres, F 1991Intraoperative monitoring of the facial nerve during decompressive surgery for hemifacial spasm.J Neurosurg74254257PubMedGoogle Scholar
  10. Hatem, J, Sindou, M, Vial, C 2001Intraoperative monitoring of facial EMG responses during microvascular decompression for hemifacial spasm. Prognostic value for long-term outcome: a study in a 33 patient series.Brit J Neurosurg15496499CrossRefGoogle Scholar
  11. Hopf, HC, Lowitzsch, K 1982Hemifacial spasm: location of the lesion by electrophysiological means.Muscle Nerve [Suppl]5584588Google Scholar
  12. Illingworth, RD, Porter, DG, Sakubowski, J 1996Hemifacial spasm: a prospective long-term follow-up of 83 cases treated by microvascular decompression at two neurosurgical centres in the UK.Neurol Neurosurg Psychiat607277Google Scholar
  13. Isu, T, Kamoda, K, Mabuci, S, Kitaoka, A, Ito, T, Koiwa, M, Abe, H 1996Intra-operative monitoring by facial electromyographic responses during microvascular decompressive surgery for hemifacial spasm.Acta Neurochir (Wien)1381923CrossRefGoogle Scholar
  14. Jannetta, PJ 1970Microsurgical exploration and decompression of the facial nerve in hemifacial spasm.Curr Top Surg Res2217220Google Scholar
  15. Jannetta, PJ 1984Hemifacial spasm caused by a venule: case report.Neurosurgery148992PubMedGoogle Scholar
  16. Jannetta, PJ, Abbassy, M, Maroon, JC, Ramos, FM, Albin, MS 1977Etiology and definitive microsurgical treatment of hemifacial spasm, operative technique and results in patients.J Neurosurg47321328PubMedGoogle Scholar
  17. Kim, P, Fukushima, T 1984Observations on synkinesis in patients with hemifacial spasm. Effect of microvascular decompression and etiological consideration.J Neurosurg60821827PubMedGoogle Scholar
  18. Magun, R, Esslen, E 1959Electromyographic study of reinnervated muscle and hemifacial spasm.Am J Phys Med387886Google Scholar
  19. Marneffe, V, Polo, G, Fischer, C, Sindou, M 2003Decompression Vasculaire Micro-Chirurgicale pour Spasme Hemifacial. Résultats cliniques à plus d’un an et facteurs pronostiques. Etude d’une série de 100 cas.Neurochirurgie495527535Google Scholar
  20. Moller AR (1997) Pathophysiology of hemifacial spasm. In: Sindou M, Keravel Y, Moller AR (eds) Hemifacial spasm. A multidisciplinary approach. Springer, Wien New York, pp 51–62Google Scholar
  21. Moller, AR 1999Vascular compression of cranial nerves II. Pathophysiology.Neurol Res21439443PubMedGoogle Scholar
  22. Moller AR (2000) Hearing: its physiology and pathophysiology. Academic Press, San DiegoGoogle Scholar
  23. Moller, AR, Jannetta, PJ 1984On the origin of synkinesis in hemifacial spasm: results of intracranial recordings.J Neurosurg61569576PubMedGoogle Scholar
  24. Moller, AR, Jannetta, PJ 1985Hemifacial spasm: results of electrophysiologic recording during microvascular decompression operations.Neurology35969974PubMedGoogle Scholar
  25. Moller, AR, Jannetta, PJ 1985Microvascular decompression in hemifacial spasm: intraoperative electrophysiological observations.Neurosurgery16612618PubMedGoogle Scholar
  26. Moller, AR, Jannetta, PJ 1987Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm.J Neurosurg66681685PubMedGoogle Scholar
  27. Moller, MB, Moller, AP 1985Loss of auditory function in microvascular decompression for hemifacial spasm: results in 143 consecutive cases.J Neurosurg631720PubMedGoogle Scholar
  28. Moller, AR, Moller, M 1989Does intraoperative monitoring of auditory evoked potentials reduce incidence of hearing loss as a complication of microvascular decompression of cranial nerves.Neurosurgery24257263PubMedGoogle Scholar
  29. Mooij, JJA, Mustapha, MK, Van Weerden, TW 2001Hemifacial spasm: intraoperative electromyographie monitoring as a guide for microvascular decompression.Neurosurgery4913651371CrossRefPubMedGoogle Scholar
  30. Payner, TD, Tew, JM 1996Recurrence of hemifacial spasm after microvascular decompression.Neurosurgery38686691CrossRefPubMedGoogle Scholar
  31. Polo, G, Fischer, C, Sindou, M, Marneffe, V 2004Brainstem auditory evoked potential monitoring during microvascular decompression for hemifacial spasm: intraoperative brainstem auditory evoked potential changes and warning values to prevent hearing loss. Prospective study in a consecutive series of 84 patients.Neurosurgery5497106CrossRefPubMedGoogle Scholar
  32. Sauvain MO, Magistris MR, de Tribolet N (2001) Microvascular decompression of the facial nerve. In: Spetzler R (ed) Operative techniques in neurosurgery, vol 4. Saunders, Philadelphia, pp 127–136Google Scholar
  33. Shikawa, M, Ohira, T, Namiki, J, Gotoh, K, Takase, M, Toya, S 1996Electrophysiological investigation of hemifacial spasm: F waves of the facial muscles.Acta Neurochir (Wien)1382432CrossRefGoogle Scholar
  34. Shikawa, M, Ohira, T, Namiki, J, Kobayashi, M, Takase, M, Kawase, T, Toya, J 1997Electrophysiological investigation of hemifacial spasm after microvascular decompression: F waves of the facial muscles, blink reflexes and abnormal muscle responses.J Neurosurg86654661PubMedGoogle Scholar
  35. Sindou M, Ciriano D, Fischer C (1991) Lessons from brainstem auditory evoked potential monitoring during microvascular decompression for trigeminal neuralgia and hemifacial spasm. In: Schramm J, Moller AR (eds) Intraoperative neurophysiologic monitoring in neurosurgery. Springer Berlin Heidelberg New York Tokyo, pp 293–300Google Scholar
  36. Sindou, M, Fobe, JL, Ciriano, D, Fischer, C 1992Hearing prognosis and intraoperative guidance of brainstem auditory evoked potentials in microvascular decompression.Laryngoscope102678682PubMedGoogle Scholar
  37. Sindou M, Fischer C, Derraz S, Keravel Y, Palfi S (1997) Microvascular surgical decompression for hemifacial spasm: a retrospective study of a patients series. In: Sindou M Keravel Y, Moller AR (eds) Hemifacial spasm, a multidisciplinary approach. Springer, Wien New York, pp 93–106Google Scholar
  38. Sindou M, Keravel Y, Moller A (1997) Hemifacial spasm. A multidisciplinary approach. Springer, Wien New YorkGoogle Scholar
  39. Watanabe, E, Schramm, J, Strauss, C, Fahlbusch, R 1989Neurophysiologic monitoring in posterior fossa surgery. Part II: BAEP-waves I and V and preservation of hearing.Acta Neurochir (Wien)98118128CrossRefGoogle Scholar
  40. Wilkins, RH 1991Hemifacial spasm: a review.Surg Neurol36251277CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2005

Authors and Affiliations

  • M. P. Sindou
    • 1
  1. 1.Department of NeurosurgeryHopital Neurologique, University of LyonLyonFrance

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