Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Neurosurgery. 2020 Sep 15;87(4):E473-E484. doi: 10.1093/neuros/nyaa069.
Microvascular decompression (MVD) is the surgical treatment of choice for hemifacial spasm (HFS). During MVD, monitoring of the abnormal lateral spread response (LSR), an evoked response to facial nerve stimulation, has been traditionally used to monitor adequacy of cranial nerve (CN) VII decompression.
To assess the utility of LSR monitoring in predicting spasm-free status after MVD postoperatively.
We searched PubMed, Web of Science, and Embase for relevant publications. We included studies reporting on intraoperative LSR monitoring during MVD for HFS and spasm-free status following the procedure. Sensitivity of LSR, specificity, diagnostic odds ratio, and positive predictive value were calculated.
From 148 studies, 26 studies with 7479 patients were ultimately included in this meta-analysis. The final intraoperative LSR status predicted the clinical outcome of MVD with the following specificities and sensitivities: 89% (0.83- 0.93) and 40% (0.30- 0.51) at discharge, 90% (0.84-0.94) and 41% (0.29-0.53) at 3 mo, 89% (0.83-0.93) and 40% (0.30-0.51) at 1 yr. When LSR persisted after MVD, the probability (95% CI) for HFS persistence was 47.8% (0.33-0.63) at discharge, 40.8% (0.23-0.61) at 3 mo, and 24.4% (0.13-0.41) at 1 yr. However, when LSR resolved, the probability for HFS persistence was 7.3% at discharge, 4.2% at 3 mo, and 4.0% at 1 yr.
Intraoperative LSR monitoring has high specificity but modest sensitivity in predicting the spasm-free status following MVD. Persistence of LSR carries high risk for immediate and long-term facial spasm persistence. Therefore, adequacy of decompression should be thoroughly investigated before closing in cases where intraoperative LSR persists.
微血管减压术（MVD）是治疗面肌痉挛（HFS）的首选手术方法。在 MVD 过程中，监测异常的外侧扩散反应（LSR），即面神经刺激的诱发电位，一直被用于监测颅神经（CN）VII 减压的充分性。
评估 LSR 监测在预测 MVD 术后无痉挛状态中的作用。
我们在 PubMed、Web of Science 和 Embase 上搜索了相关文献。我们纳入了报道 MVD 术中 LSR 监测和术后 HFS 无痉挛状态的研究。计算了 LSR 的灵敏度、特异性、诊断优势比和阳性预测值。
从 148 项研究中，最终有 26 项研究共 7479 例患者纳入了本荟萃分析。最终术中 LSR 状态预测了 MVD 的临床结果，其特异性和灵敏度分别为：出院时为 89%（0.83-0.93）和 40%（0.30-0.51），3 个月时为 90%（0.84-0.94）和 41%（0.29-0.53），1 年时为 89%（0.83-0.93）和 40%（0.30-0.51）。当 MVD 后 LSR 持续存在时，HFS 持续存在的概率（95%CI）为出院时为 47.8%（0.33-0.63），3 个月时为 40.8%（0.23-0.61），1 年时为 24.4%（0.13-0.41）。然而，当 LSR 消失时，HFS 持续存在的概率为出院时 7.3%，3 个月时 4.2%，1 年时 4.0%。
术中 LSR 监测在预测 MVD 后无痉挛状态方面具有高特异性，但灵敏度中等。LSR 的持续存在提示即刻和长期面肌痉挛持续存在的风险较高。因此，在术中 LSR 持续存在的情况下，应在关闭前彻底检查减压的充分性。
