Department of Neurosurgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, South Korea.
Neurosurg Rev. 2021 Dec;44(6):3259-3266. doi: 10.1007/s10143-020-01267-6. Epub 2021 Feb 9.
The lateral spread response (LSR) on preoperative facial electromyogram (EMG) is a useful tool in evaluating patients with hemifacial spasm (HFS). There may be some instances where the LSR does not appear on the preoperative EMG, thus disrupting the diagnosis and treatment of HFS. In this study, we evaluated the patients who did not exhibit LSR on preoperative EMG but underwent microvascular decompression (MVD) for hemifacial spasm. We searched for patients who underwent MVD for HFS but had an absence of LSR on preoperative EMG between January 2016 and June 2018. Surgical outcomes were evaluated at 1, 3, and 6 months after surgery. Follow-up facial EMG was performed 3 months after surgery. Results were divided into two categories: (1) spasm relief within 24 h of surgery and (2) spasm was observed immediately post-operation. The following parameters were analyzed when comparing between the two groups: age, sex, affected side, duration of symptoms, and offending vessel(s). A total of 306 patients underwent MVD for HFS during the study period. Among them, 13 (4.2%) patients had no LSR on preoperative EMG. Eight patients (61.5%) were female and five patients were male. The 13 patients had a mean age of 51 years. All patients exhibited probable offending vessels in the root exit zone (REZ) of the facial nerve on preoperative magnetic resonance (MR) imaging that was confirmed during surgery. Seven patients were free of HFS immediately after surgery, though six patients were not. Only one (7.7%) patient had persisted symptom 6 months after surgery. No patients experienced recurrence of spasm, nor exhibited abnormal waves on follow-up facial EMG. LSR on facial EMG is a valuable tool for evaluating hemifacial spasm. However, although LSR did not appear on preoperative EMG, if the patient presents with typical symptoms and the offending vessels are identified on MRI, we expect good results after MVD for HFS.
术前面部肌电图（EMG）的侧扩散反应（LSR）是评估面肌痉挛（HFS）患者的有用工具。在某些情况下，术前 EMG 上可能不会出现 LSR，从而干扰 HFS 的诊断和治疗。在这项研究中，我们评估了那些在术前 EMG 上未出现 LSR 但接受微血管减压术（MVD）治疗面肌痉挛的患者。我们搜索了 2016 年 1 月至 2018 年 6 月期间接受 MVD 治疗 HFS 但术前 EMG 上无 LSR 的患者。在手术后 1、3 和 6 个月评估手术结果。术后 3 个月进行随访面部 EMG。结果分为两类：（1）手术 24 小时内痉挛缓解；（2）术后立即观察到痉挛。在两组之间比较时分析了以下参数：年龄、性别、受累侧、症状持续时间和肇事血管。在研究期间，共有 306 例患者接受 MVD 治疗 HFS。其中，13 例（4.2%）患者术前 EMG 无 LSR。8 例（61.5%）为女性，5 例为男性。13 例患者的平均年龄为 51 岁。所有患者在术前磁共振成像（MR）上均显示面神经神经根出口区（REZ）存在可能的肇事血管，在手术中得到证实。7 例患者术后立即无 HFS，但 6 例患者仍有 HFS。只有 1 例（7.7%）患者在术后 6 个月仍有症状。没有患者出现痉挛复发，也没有在随访面部 EMG 上出现异常波。面部 EMG 上的 LSR 是评估面肌痉挛的有价值工具。然而，尽管术前 EMG 上未出现 LSR，但如果患者出现典型症状且在 MRI 上识别出肇事血管，我们预计 MVD 治疗 HFS 会有良好的效果。
