Microvascular decompression for hemifacial spasm: long-term results from 114 operations performed without neurophysiological monitoring

Dannenbaum, Mark D.; Lega, Bradley; Suki, Dima; Harper, Richard P.; Yoshor, Daniel

doi:10.3171/jns/2008/109/9/0410

Cited by 78 publications

(57 citation statements)

References 22 publications

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“…4,7,20 In our series, we did not find any significant difference in latency and amplitude of Wave V of BAEPs during MVD in patients with and without HFHL. As part of the institutional paradigm shift, we used alarm criteria developed by the senior author (R.S.)…”

Section: Intraoperative Neuromonitoring and Alarm Criteriamentioning

confidence: 66%

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Frederickson

Balzer

Crammond

et al. 2015

JNS

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M icrovascular decompression (MVD) is a safe and efficacious procedure for the treatment of hemifacial spasm (HFS), a debilitating condition that reduces patients' quality of life. Severe sensorineural hearing loss (SNHL) across all frequencies is a known complication of the operation, with reported rates ranging from 1.4% to 20%. 4,12,[18][19][20][21]24 In addition to severe SNHL, however, a recent report has raised concern that as many as one-half of patients undergoing MVD for HFS may experience high-frequency (4-8 kHz) hearing loss.28 Although this type of hearing loss is not as obviously apparent upon clinical follow-up as severe SNHL, high-frequency hearing loss (HFHL) can profoundly reduce the quality of life of patients. 5,10 Although the prior report implicated noise from the high-speed surgical drill as the cause of HFHL following MVD, we conducted this study to examine the incidence of HFHL, with an emphasis on retractorless MVD for treatment of HFS.abbreviatioNs BAEP = brainstem auditory evoked potential; HFHL = high-frequency hearing loss; HFS = hemifacial spasm; MVD = microvascular decompression; SNHL = sensorineural hearing loss; SPL = sound pressure level. obJect Microvascular decompression is a safe and effective procedure to treat hemifacial spasm, but the operation poses some risk to the patient's hearing. While severe sensorineural hearing loss across all frequencies occurs at a low rate in experienced hands, a recent study suggests that as many as one-half of patients who undergo this procedure may experience ipsilateral high-frequency hearing loss (HFHL), and as many as one-quarter may experience contralateral HFHL. While it has been suggested that drill-related noise may account for this finding, this study was designed to examine the effect of a number of techniques designed to protect the vestibulocochlear nerve from operative manipulation on the incidence of HFHL. methods Pure-tone audiometry was performed both preoperatively and postoperatively on 67 patients who underwent microvascular decompression for hemifacial spasm during the study period. A change of greater than 10 dB at either 4 kHz or 8 kHz was considered to be HFHL. Additionally, the authors analyzed intraoperative brainstem auditory evoked potentials from this patient cohort. results The incidence of ipsilateral HFHL in this cohort was 7.4%, while the incidence of contralateral HFHL was 4.5%. One patient (1.5%; also included in the HFHL group) experienced an ipsilateral nonserviceable hearing loss. coNclusioNs The reduced incidence of HFHL in this study suggests that technical modifications including performing the procedure without the use of fixed retraction may greatly reduce, but not eliminate, the occurrence of HFHL following microvascular decompression for hemifacial spasm.

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Section: Intraoperative Neuromonitoring and Alarm Criteriamentioning

confidence: 66%

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Frederickson

Balzer

Crammond

et al. 2015

JNS

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“…1,3,9,11,28 To date, there are no reported randomized controlled trials of intraoperative EMG that were designed or powered to study cure of HFS as the primary end point. Because the majority of surgeons performing MVD for HFS believe strongly about the use of intraoperative EMG, it is unlikely that a large prospective, randomized multicenter trial will be undertaken.…”

mentioning

confidence: 99%

“…17 While several retrospective and prospective studies have strongly supported its use, 6,21,27,31 several other studies have failed to show that intraoperative EMG improves outcome (that is, a cure of HFS). 1,3,9,11,28 To date, there are no reported randomized controlled trials of intraoperative EMG that were designed or powered to study cure of HFS as the primary end point. Because the majority of surgeons performing MVD for HFS believe strongly about the use of intraoperative EMG, it is unlikely that a large prospective, randomized multicenter trial will be undertaken.…”

mentioning

confidence: 99%

Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis

Sekula

Bhatia²,

Frederickson³

et al. 2009

FOC

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Object In this paper, the authors' goal was to determine the utility of monitoring the abnormal muscle response (AMR) or “lateral spread” during microvascular decompression surgery for hemifacial spasm. Methods The authors' experience with AMR as well as the data available in the English-language literature regarding resolution or persistence of AMR and the resolution or persistence of hemifacial spasm at follow-up was pooled and subjected to a meta-analysis. Results The pooled OR revealed by the meta-analysis was 4.2 (95% CI 2.7–6.7). The chance of a cure if the AMR was abolished during surgery was 4.2 times greater than if the lateral spread persisted. Conclusions The AMR should be monitored routinely in the operating room, and surgical decision-making in the operating room should be augmented by the AMR.

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“…36,40 Success of MVD for hemifacial spasm at 10 years is even slightly better, with rates approaching 80%-85%. 8 In the modern era, improving the value of an episode of care, for example the surgical treatment of trigeminal neuralgia or hemifacial spasm via MVD, will not only rely on measures to optimize resolution of trigeminal neuralgia or hemifacial spasm with no procedure-related complication (symptomatic or radiographic) or mortality; the capacity of optimizing the value of a surgical care episode will also depend on numerous other factors, such as minimizing the duration of anesthesia, preventing blood transfusion, optimal postoperative pain and nausea management, and early nutrition and ambulation. Length of stay will also be an important measure, as it represents a surrogate marker of multidisciplinary coordinated and organized care as well as a marker of efficient minimally invasive, complicationfree surgery.…”

Section: Realistic Goal Of An "Optimal Surgery" or "Optimal Surgical mentioning

confidence: 99%

Value-based neurosurgery: the example of microvascular decompression surgery

McLaughlin¹,

Buxey²,

Chaw³

et al. 2014

JNS

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Object Value of care is emerging as a promising framework to restructure health care, emphasizing the importance of reporting multiple outcomes that encompass the entire care episode instead of isolated outcomes specific to care points during a patient's care. The authors assessed the impact of coordinated implementation of processes across the episode of surgical care on value of neurosurgical care, using microvascular decompression (MVD) as an example. Methods This study is a retrospective review of consecutive cases involving patients with either trigeminal neuralgia or hemifacial spasm undergoing first-time MVD. Patients were divided into 2 groups: Group 1 included patients who underwent surgery between February 2008 and November 2009 and Group 2 included those who underwent surgery between January 2011 and October 2012. The authors collected data on outcome measures spanning the entire surgical episode of care according to the Outcome Measures Hierarchy. Results Forty-nine patients were included: 20 patients in Group 1 and 29 patients in Group 2. Thirty-one patients underwent MVD for trigeminal neuralgia and 18 for hemifacial spasm. A zero mortality rate and high degree of symptom resolution were achieved in both groups. Group 2 benefited from a reduction in the average total operating room time, a decrease in the mean and median postoperative length of hospital stay, a decrease in the mean length of stay on the floor, and a reduction in the rates of complications and readmissions. Conclusions Comprehensive implementation of improvement processes throughout the continuum of care resulted in improved global outcome and greater value of delivered care. Enhanced-recovery perioperative protocols and diagnosis-specific clinical pathways are two avenues built around global care delivery that can help achieve an “optimal episode of surgical care” in every case.

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Microvascular decompression for hemifacial spasm: long-term results from 114 operations performed without neurophysiological monitoring

Cited by 78 publications

References 22 publications

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Reduction in high-frequency hearing loss following technical modifications to microvascular decompression for hemifacial spasm

Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis

Value-based neurosurgery: the example of microvascular decompression surgery

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