Faculty of Medicine, University of Leuven, Leuven, Belgium.
Department of Neurology, University Hospital Leuven, University of Leuven, Leuven, Belgium.
Br J Neurosurg. 2022 Jun;36(3):346-357. doi: 10.1080/02688697.2022.2049701. Epub 2022 Mar 22.
To review the diagnostic accuracy and possible added value of Brainstem Auditory Evoked Potentials (BAEP) monitoring and Lateral Spread Response (LSR) monitoring in microvascular decompression surgery for hemifacial spasms.
For this systematic review we followed the PRISMA guidelines. We searched different databases and bibliographies of articles. We included studies on BAEP and LSR monitoring that reported data on hearing outcome or efficacy. Selected studies were assessed for bias using the MINORS tool.
64 articles were selected for qualitative synthesis, 42 met inclusion criteria for meta-analysis. The overall incidence of hearing loss was 3.4%. For BAEP monitoring AUC and pooled OR with 95% confidence interval were 0.911 (0.753-0.933) and 7.99 (3.85-16.60) respectively. Short-term data on LSR monitoring showed an overall spasm relief rate of 89% with pooled OR, sensitivity and specificity with a 95% confidence interval of 8.80 (4.82-16.08), 0.911 (0.863-0.943) and 0.451 (0.342-0.564) respectively. Long-term data on LSR monitoring showed an overall spasm relief rate of 95% with pooled OR, sensitivity and specificity with a 95% confidence interval of 4.06 (2.15-7.64), 0.871 (0.817-0.911) and 0.39 (0.294-0.495) respectively.
The alarm criteria, a wave V latency prolongation of 1ms or a wave V amplitude decrement of 50%, proposed by the 'American Clinical Neurophysiology Society' are a sensitive predictor for postoperative hearing loss. Other BAEP wave changes, for example, complete loss of wave V, are more specific but correspond to irreversible damage and are therefore not useful as warning criteria. LSR monitoring has high diagnostic accuracy at short-term follow-up. At long-term follow-up, diagnostic accuracy decreases because most patients get spasm relief regardless of their LSR status. LSR persistence after surgery has a good long-term outcome, as long as an extensive exploration of the facial nerve has been performed.
综述脑干听觉诱发电位（BAEP）监测和侧向扩散反应（LSR）监测在面肌痉挛微血管减压术中的诊断准确性和可能的附加价值。
本系统评价遵循 PRISMA 指南。我们搜索了不同的数据库和文章的参考文献。我们纳入了报告听力结果或疗效数据的 BAEP 和 LSR 监测研究。使用 MINORS 工具评估选定研究的偏倚。
定性综合分析了 64 篇文章，42 篇符合荟萃分析纳入标准。听力损失的总发生率为 3.4%。对于 BAEP 监测，AUC 和汇总 OR 及其 95%置信区间分别为 0.911（0.753-0.933）和 7.99（3.85-16.60）。LSR 监测的短期数据显示总体痉挛缓解率为 89%，汇总 OR、敏感性和特异性及其 95%置信区间分别为 8.80（4.82-16.08）、0.911（0.863-0.943）和 0.451（0.342-0.564）。LSR 监测的长期数据显示总体痉挛缓解率为 95%，汇总 OR、敏感性和特异性及其 95%置信区间分别为 4.06（2.15-7.64）、0.871（0.817-0.911）和 0.39（0.294-0.495）。
“美国临床神经生理学学会”提出的报警标准，即波 V 潜伏期延长 1ms 或波 V 幅度降低 50%，是术后听力损失的敏感预测指标。其他 BAEP 波变化，例如波 V 完全缺失，更具特异性，但对应不可逆损伤，因此不作为预警标准有用。LSR 监测在短期随访时具有较高的诊断准确性。在长期随访中，由于大多数患者无论 LSR 状态如何都能缓解痉挛，因此诊断准确性降低。手术后 LSR 持续存在具有良好的长期预后，只要对面神经进行了广泛的探查。
