Monitoring of the lateral spread response combined with brainstem auditory evoked potentials in microvascular decompression for hemifacial spasm.

OBJECTIVE

Despite high cure rates, symptom persistence and auditory dysfunction occur sometimes after microvascular decompression (MVD) surgery for hemifacial spasm (HFS). This study evaluated whether combined intraoperative monitoring of the lateral spread response (LSR) and brainstem auditory evoked potentials (BAEP) can reduce the incidence of hearing impairment following MVD for HSF.

METHODS

A total of 244 HFS patients undergoing MVD were prospectively included and divided into an LSR monitoring group (121 cases) and a combined LRS + BAEP monitoring group (123 cases). Intraoperative recordings of abnormal muscle response (AMR) waves and BAEP were collected and correlated with postoperative HFS and hearing status.

RESULTS

HFS symptoms were similarly improved in the two groups, with no significant differences in the occurrence of AMR or the probability of AMR disappearance postoperatively. For both groups, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of AMR waves were also comparable. However, the incidence of postoperative hearing impairment was significantly lower in the LSR + BAEP group compared to the LSR group. Furthermore, receiver operating characteristic (ROC) analysis of BAEP's performance revealed an area under the ROC curve (AUC) of 0.991 (95% CI: 0.955-1.000), indicating a high diagnostic value of BAEP for predicting postoperative hearing decline.

CONCLUSION

LSR monitoring is a reliable approach for assessing the effectiveness of MVD surgery for the facial nerve. The combination of LSR monitoring with BAEP does not affect diagnostic accuracy. More importantly, BAEP can sensitively reflect patients' hearing changes during surgery due to its high diagnostic value, guiding surgeons to adjust their intraoperative techniques and effectively reducing the incidence of postoperative hearing impairment.