Al Menabbawy Ahmed, Eisold Marie, Refaee Ehab El, Lange Ina, Peters Ines, Matthes Marc, Schroeder W S
Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany.
Department of Neurosurgery, Cairo University, Cairo, Egypt.
Acta Neurochir (Wien). 2025 Aug 29;167(1):232. doi: 10.1007/s00701-025-06642-0.
Prognostic significance of lateral spreads response (LSR) disappearance in microvascular decompression (MVD) for hemifacial spasm (HFS) remains controversial. Still the timing of LSR disappearance and its association with overall outcomes has not been sufficiently investigated. We evaluate the prognostic significance of the timing of LSR disappearance during MVD in HFS.
Prospective documentation of the LSR-Status during the procedural steps was performed alongside routinely collected data. Surgical steps were categorized into three phases: Opening phase (skin incision till cisternal opening), arachnoid dissection, and actual Decompression phase. Outcome assessment was conducted after a follow-up period of at least 12 months, with favorable outcome defined as at least 90% resolution of the spasms.
214 patients were included with a mean age (SD) of 54.9 ± 11.6 years and a follow-up duration (SD) of 25.8 ± 15.7 months. The male-to-female ratio was 1:1.6. LSR was "not detected" in 32 patients (15.0%), with a 93.8% favorable outcome. LSR "persisted" in 22 patients (10.3%), showing only 77.3% favorable outcome. In 16 patients (7.4%), LSR disappeared during the opening phase, yielding a 100% favorable outcome. LSR disappearance occurred during arachnoid dissection in 40 patients (18.7%), with a 91.1% favorable outcome. Finally, LSR disappearance following nerve decompression was observed in 104 patients (48.6%), showing a 78.9% favorable outcome. Earlier disappearance of the LSR was associated with long-term cure (P-value < 0.05).
LSR may serve as a valuable intraoperative indicator during MVD for HFS. Early intraoperative disappearance of the LSR may predict favorable long-term outcomes. However, the disappearance of the LSR in general does not consistently correlate with surgical success.
微血管减压术（MVD）治疗面肌痉挛（HFS）时，患侧扩散反应（LSR）消失的预后意义仍存在争议。LSR消失的时间及其与总体预后的关系尚未得到充分研究。我们评估HFS患者MVD期间LSR消失时间的预后意义。
在手术步骤中对LSR状态进行前瞻性记录，并与常规收集的数据一起进行。手术步骤分为三个阶段：开放阶段（皮肤切口至脑池开放）、蛛网膜分离和实际减压阶段。在至少12个月的随访期后进行结果评估，良好结果定义为痉挛至少缓解90%。
纳入214例患者，平均年龄（标准差）为54.9±11.6岁，随访时间（标准差）为25.8±15.7个月。男女比例为1:1.6。32例患者（15.0%）未检测到LSR，良好结果率为93.8%。22例患者（10.3%）LSR持续存在，良好结果率仅为77.3%。16例患者（7.4%）在开放阶段LSR消失，良好结果率为100%。40例患者（18.7%）在蛛网膜分离期间LSR消失，良好结果率为91.1%。最后，104例患者（48.6%）在神经减压后LSR消失，良好结果率为78.9%。LSR较早消失与长期治愈相关（P值<0.05）。
LSR可能是HFS患者MVD术中的一个有价值的指标。术中早期LSR消失可能预示长期良好预后。然而，LSR的消失总体上与手术成功并不一致相关。
