Nugroho Setyo Widi, Perkasa Sayyid Abdil Hakam, Gunawan Kevin, Manuhutu Yovanka Naryai, Rahman Muhamad Aulia, Rizky Amal
Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia.
Heliyon. 2021 Feb 2;7(2):e06115. doi: 10.1016/j.heliyon.2021.e06115. eCollection 2021 Feb.
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.
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.
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.
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.
微血管减压术已被确立为面肌痉挛的主要治疗方法。手术过程中使用术中监测来指导神经外科医生确定面神经与血管的减压是否充分。我们进行了一项系统评价，以评估侧方扩散反应（LSR）监测在预测微血管减压术后面肌痉挛疗效中的作用。
对PubMed、ScienceDirect、Cochrane和谷歌学术进行系统检索。我们纳入了进行微血管减压手术并进行术中监测以分析侧方扩散反应与痉挛缓解之间相关性的研究。对所选研究进行了严格评价。
纳入了22项研究，共6404例面肌痉挛患者，这些患者接受了术中监测的微血管减压手术。在15篇评估术后不久症状的文章中，12项研究表明侧方扩散反应消失与痉挛消失之间存在显著相关性。在6项评估3个月随访结果的研究中，有4项显示LSR与结果之间存在显著关系，在6项评估6个月随访时痉挛缓解情况的文章中，有5项也是如此。多达62.5%的研究（16项中的10项）显示长期随访（≥1年）结果不显著。
微血管减压手术中的术中监测可作为预测面肌痉挛缓解情况的有用工具。虽然LSR缓解和持续的患者长期预后相似，但术后不久症状的缓解将为患者带来舒适，从而提高他们的生活质量。
