Predictive value of intraoperative blink reflex monitoring for surgical outcome during microvascular decompression for hemifacial spasm. Issue 9 (September 2020)

• Record Type: Journal Article
• Authors: Choi, Jongsuk; Yang, Sejin; Kim, Jun-Soon; Han, Jung Ho; Park, Kyung Seok
• Is Part Of: Clinical neurophysiology. Volume 131:Issue 9(2020:Sep.)
• Page Start: 2268
• Page End: 2275
• Publication Date: 2020-09
• Subjects: Hemifacial spasm -- Microvascular decompression -- Intraoperative neurophysiological monitoring -- Blink reflex -- Lateral spread response; BR blink reflex -- HFS hemifacial spasm -- LSR lateral spread response -- MVD microvascular decompression; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2020.06.025
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Intraoperative blink reflex (BR) monitoring helps optimize the effectiveness of microvascular decompression for hemifacial spasm. Compared with lateral spread response, intraoperative BR monitoring shows better predictive value. Intraoperative BR monitoring might be a useful and reliable prognostic predictor of surgical outcome. Abstract: Objective: To investigate the prognostic and predictive value of intraoperative blink reflex (BR) monitoring during microvascular decompression (MVD) for hemifacial spasm (HFS). Methods: We retrospectively reviewed 41 patients with HFS undergoing MVD with intraoperative BR and lateral spread response (LSR) monitoring. Facial spasm was evaluated for six months postoperatively. Results: The BR resolved in 38 patients and persisted in three after MVD. For patients who exhibited BR resolution, 1-day, 1-month, and 6-month follow-ups revealed that 35 (92.1%), 35 (92.1%), and 38 (100%) patients had spasm resolution, respectively. However, of the three patients with persistent BR, one (33.3%), one (33.3%), and zero (0%) patients exhibited spasm resolution at the three corresponding follow-ups. We found a statistically significant difference in spasm resolution between the persistent and resolved BR groups at six months postoperatively. A comparison between intraoperative BR and LSR monitoring revealed that BR was a better predictor of clinical outcomes. Conclusions: Intraoperative BR monitoring is a potentially useful tool to help facilitate an adequate decompression and is a reliable prognostic predictor of surgical outcome. Significance: This study is the first to document the relationship between intraoperative BR monitoring and surgical outcome in patients with HFS.