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Cho KR, Lee HS, Kim M, Park SK, Park K. Optimal method for reliable lateral spread response monitoring during microvascular decompression surgery for hemifacial spasm. Sci Rep 2023; 13:21672. [PMID: 38066203 PMCID: PMC10709590 DOI: 10.1038/s41598-023-49008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
In this study, we propose an optimal method for monitoring the key electrophysiological sign, the Lateral Spread Response (LSR), during microvascular decompression (MVD) surgery for hemifacial spasm (HFS). Current monitoring methods and interpretations of LSR remain unclear, leading to potential misinterpretations and undesirable outcomes." We prospectively collected data from patients undergoing MVD for HFS, including basic demographics, clinical characteristics, and surgical outcomes. Stimulation intensity was escalated by 1 mA increments to identify the optimal range for effective LSR. We designated the threshold at which we can observe LSR as THR1 and THR2 for when LSR disappears, with high-intensity stimulation (30 mA) designated as THR30. Subsequently, we compared abnormal muscle responses (AMR) between the optimal range (between THR1 and THR2) and THR30. Additionally, we conducted an analysis to identify and assess factors associated with artifacts and their potential impact on clinical outcomes. As stimulation intensity increases, the onset latency to detect AMR was shortened. The first finding of the study was high intensity stimulation caused artifact that mimic the wave of LSR. Those artifacts were observed even after decompression thus interfere interpretation of disappearance of LSR. Analyzing the factors related to the artifact, we found the AMR detected at onset latency below 9.6 ms would be the lateral spreading artifact (LSA) rather than true LSR. To avoid false positive LSR from LSA, we should stepwise increase stimulation intensity and not to surpass the intensity that cause LSR onset latency below 10 ms.
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Affiliation(s)
- Kyung Rae Cho
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea
| | - Hyun-Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, 25440, Republic of Korea
| | - Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea.
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, 120, Neungdong-ro, Gwangjin-gu, 05029, Seoul, Republic of Korea.
- Department of Neurosurgery, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
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Yang LN, Chen C, Zhao DD, Hu M, Li JC, Yang MC. Influence of Minimum Alveolar Concentration and Inhalation Duration of Sevoflurane on Facial Nerve Electromyography in Hemifacial Spasm: A Randomized Controlled Trial. J Neurosurg Anesthesiol 2023; 35:375-383. [PMID: 35575766 DOI: 10.1097/ana.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/25/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The lateral spread response (LSR) is an electromyography feature of hemifacial spasm; intraoperative reduction in the LSR is associated with positive surgical outcomes. This study examined the effects of different minimum alveolar concentrations (MACs) and durations of sevoflurane inhalation on the LSR. METHODS Eighty patients undergoing microvascular decompression surgery for hemifacial spasm were randomly allocated to receive propofol-remifentanil total intravenous anesthesia alone or in combination with sevoflurane at 0.5, 0.75, or 1 MAC. The LSR and orbicularis oculi muscle wave were recorded before and at 15 and 30 minutes after the start of sevoflurane administration. RESULTS Sevoflurane reduced the LSR amplitude in a dose-dependent and duration-dependent manner. The curve representing the LSR amplitude preservation ratio change according to sevoflurane concentration is best fitted by regression analysis using a cubic model, as the cubic equations had the largest coefficient of determination; at 15 minutes ( R2 =0.76, F =78.36, P <0.05) and at 30 minutes ( R2 =0.882, F =189.94, P <0.05). The inhibitory effect of sevoflurane on the LSR amplitude was greater in the first 15 minutes than in the second 15 minutes of sevoflurane administration. Sevoflurane at 1 MAC for 30 minutes mildly decreased the amplitude of the orbicularis oculi muscle wave. The latencies of the LSR and the orbicularis oculi muscle wave were not affected by sevoflurane at all MACs studied. CONCLUSIONS The combination of intravenous propofol-remifentanil anesthesia with 0.5 MAC sevoflurane allows reliable intraoperative LSR monitoring in hemifacial spasm patients. Our findings support the central rather than peripheral hypothesis of the LSR.
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Affiliation(s)
| | - Chan Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Dong-Dong Zhao
- Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital
| | - Miao Hu
- Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital
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Cho KR, Park SK, Park K. Lateral Spread Response: Unveiling the Smoking Gun for Cured Hemifacial Spasm. Life (Basel) 2023; 13:1825. [PMID: 37763229 PMCID: PMC10532564 DOI: 10.3390/life13091825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/11/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
Hemifacial spasm (HFS) is a rare disorder characterized by involuntary facial muscle contractions. The primary cause is mechanical compression of the facial nerve by nearby structures. Lateral spread response (LSR) is an abnormal muscle response observed during electromyogram (EMG) testing and is associated with HFS. Intraoperative monitoring of LSR is crucial during surgery to confirm successful decompression. Proper anesthesia and electrode positioning are important for accurate LSR monitoring. Stimulation parameters should be carefully adjusted to avoid artifacts. The disappearance of LSR during surgery is associated with short-term outcomes, but its persistence does not necessarily indicate poor long-term outcomes. LSR monitoring has both positive and negative prognostic value, and its predictive ability varies across studies. Early disappearance of LSR can occur before decompression and may indicate better clinical outcomes. Further research is needed to fully understand the implications of LSR monitoring in HFS surgery.
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Affiliation(s)
- Kyung Rae Cho
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (K.R.C.); (S.K.P.)
| | - Sang Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (K.R.C.); (S.K.P.)
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea; (K.R.C.); (S.K.P.)
- Department of Neurosurgery, School of Medicine Sungkyunkwan University, Seoul 16419, Republic of Korea
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Jeon C, Jung NY, Kim M, Park K. Intraoperative Monitoring of the Facial Nerve during Microvascular Decompression for Hemifacial Spasm. Life (Basel) 2023; 13:1616. [PMID: 37511991 PMCID: PMC10381659 DOI: 10.3390/life13071616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
This review article discusses the clinical significance of intraoperative neurophysiological monitoring (IONM), provides recommendations for monitoring protocols, and considers the interpretation of results in microvascular decompression (MVD) for hemifacial spasm (HFS). The lateral spread response (LSR) is an important monitoring parameter during MVD. It helps to identify the responsible blood vessel and confirms its thorough decompression from the facial nerve. The disappearance of the LSR during surgery is associated with favorable clinical outcomes. Standard and revised monitoring protocols and the confirmation of LSR persistence and disappearance are also discussed. The blink reflex and other facial nerve monitoring modalities, such as free-running electromyography, facial motor evoked potentials, F-waves, and the Z-L response, are further considered.
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Affiliation(s)
- Chiman Jeon
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
| | - Na Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung 25440, Republic of Korea
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
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Chai S, Wu J, Cai Y, Zhao J, Mei Z, Zhou Y, Wang Y, Xu H, Zhou J, Xiong N. Early lateral spread response loss during microvascular decompression for hemifacial spasm: its preoperative predictive factors and impact on surgical outcomes. Neurosurg Rev 2023; 46:174. [PMID: 37442820 DOI: 10.1007/s10143-023-02083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
When early lateral spread response (LSR) loss before decompression in HFS surgery happens, the value of intraoperative monitoring of LSR for locating neurovascular conflicts and confirming adequate decompression was considered to be reduced. This study aimed to identify preoperative parameters predicting early LSR loss and figure out the impact of early LSR loss on prognosis. Hemifacial spasm (HFS) patients who received microvascular decompression (MVD) under intraoperative electrophysiological monitoring during the period of March 2013-January 2021 were reviewed retrospectively. The patients were divided into two groups according to the disappearance of their LSR before or after decompression. Preoperative clinical and radiological predictors for early LSR loss were evaluated using logistic regression. The relationship between early LSR loss and surgical outcomes was statistically analyzed. A total of 523 patients were included in the study, and the disappearance of their LSR before decompression occurred in 129 patients. In the multivariate analysis, three independent factors predicting early LSR loss were identified: (1) smaller vessel compression; (2) milder nerve deviation; (3) lower posterior fossa crowdedness index (PFCI, calculated as hindbrain volume (HBV)/the posterior fossa volume (PFV) using 3D Slicer software). The median follow-up time was about five years, and no significant differences in the spasm relief and complication rates were found between the 2 groups. Smaller responsible vessels, milder nerve deviation, and more spacious posterior cranial fossa are associated with early LSR loss. However, early LSR loss seems to have no significant adverse effect on MVD outcomes in skilled hands.
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Affiliation(s)
- Songshan Chai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
| | - Ji Wu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
- Department of Neurosurgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Yuankun Cai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
| | - Jingwei Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
| | - Zhimin Mei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
| | - Yixuan Zhou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China
| | - Yihao Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Xu
- Department of Neurosurgery, Wuhan Changjiang Shipping General Hospital, Wuhan, China.
| | - Jiabin Zhou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China.
| | - Nanxiang Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, 430071, Wuhan, Hubei, China.
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Baskar D, Vengalil S, Nashi S, Kamble NL, Nalini A. Respiratory Shoulder Synkinesis: A Rare Case Report. Ann Indian Acad Neurol 2023; 26:610-611. [PMID: 37970296 PMCID: PMC10645221 DOI: 10.4103/aian.aian_235_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Dipti Baskar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Nitish L. Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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7
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Amano Y, Asayama B, Noro S, Abe T, Okuma M, Honjyo K, Seo Y, Nakamura H. Significant Correlation between Delayed Relief after Microvascular Decompression and Morphology of the Abnormal Muscle Response in Patients with Hemifacial Spasm. Neurol Med Chir (Tokyo) 2022; 62:513-520. [PMID: 36184478 DOI: 10.2176/jns-nmc.2022-0145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although microvascular decompression (MVD) is a reliable treatment for hemifacial spasm (HFS), postoperative delayed relief of persistent HFS is one of the main issues. In patients with hemifacial spasm, stimulation of a branch of the affected facial nerve elicits an abnormal response in the muscles innervated by another branch. Several specific types of waves were found in the abnormal muscle response (AMR). This study aimed to confirm the relationship between the initial morphology of the AMR wave and delayed relief of persistent HFS after MVD. We retrospectively analyzed and compared the data from 47 of 155 consecutive patients who underwent MVD for HFS at our hospital between January 2015 and March 2020. Based on the pattern of the initial AMR morphology on orbicularis oculi and mentalis muscle stimulation, patients were divided into two groups, namely, the monophasic and polyphasic groups. The results of MVD surgery for HFS were evaluated 1 week, 1 month, and 1 year postoperatively, by evaluating whether or not the symptoms of HFS persisted at the time of each follow-up. There were significantly higher rates of persistent postoperative HFS in patients with the polyphasic type of initial AMR at 1 week and 1 month after the surgery (p < 0.05, respectively), as assessed using Yates chi-squared test and Fisher's exact test. A significant correlation was observed between delayed relief after MVD and polyphasic morphology of the AMR in electromyographic analysis in patients with hemifacial spasm.
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Affiliation(s)
- Yuki Amano
- Department of Neurosurgery, Nakamura Memorial Hospital
| | | | - Shusaku Noro
- Department of Neurosurgery, Nakamura Memorial Hospital
| | - Takenori Abe
- Department of Neurology, Nakamura Memorial Hospital
| | | | - Kaori Honjyo
- Department of Neurosurgery, Nakamura Memorial Hospital
| | - Yoshinobu Seo
- Department of Neurosurgery, Nakamura Memorial Hospital
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Citron I, Thomson D, Pescarini E, Creasy H, Sorooshian P, Berner JE, Neville C, Kannan RY, Nduka C. Descriptive Study of Facial Motor Cocontractions During Voluntary Facial Movement in a Healthy Population: A New Hypothesis Contributing to Synkinesis. Facial Plast Surg Aesthet Med 2022; 25:244-249. [PMID: 36083281 DOI: 10.1089/fpsam.2022.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Motor overflow refers to involuntary movements that accompany voluntary movements in healthy individuals. This may have a role in synkinesis. Objective: To describe the frequency and magnitude of facial motor overflow in a healthy population. Methodology: Healthy participants performed unilateral facial movements: brow elevation, wink, snarl, and closed smile. Two reviewers analyzed the magnitude of each movement and cocontraction. Patterns of movements are described. Univariate analysis was used to assess the relationship between efficacy of unilateral facial control and the frequency and magnitude of cocontractions. Results: Eighty-nine participants completed the videos. Consensual mirror movements occurred in 96% of participants during unilateral eye closure and 86% during brow elevation. The most common associated movement was ipsilateral eye constriction occurring during snarl (90.1%). Improved unilateral facial control was associated with a decrease in frequency and magnitude of associated movements during brow elevation, wink, and snarl. Conclusion: This study showed stereotyped patterns of motor overflow in facial muscles that resemble those in synkinesis and become more evident as unilateral control of the face decreases.
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Affiliation(s)
- Isabelle Citron
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - David Thomson
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Elena Pescarini
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
- Plastic Surgery Unit, San Bortolo Hospital, Vicenza, Italy
| | - Henrietta Creasy
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Parviz Sorooshian
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | | | - Catriona Neville
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Ruben Y Kannan
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Charles Nduka
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
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9
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Szmyd B, Sołek J, Błaszczyk M, Jankowski J, Liberski PP, Jaskólski DJ, Wysiadecki G, Karuga FF, Gabryelska A, Sochal M, Tubbs RS, Radek M. The Underlying Pathogenesis of Neurovascular Compression Syndromes: A Systematic Review. Front Mol Neurosci 2022; 15:923089. [PMID: 35860499 PMCID: PMC9289473 DOI: 10.3389/fnmol.2022.923089] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Neurovascular compression syndromes (NVC) are challenging disorders resulting from the compression of cranial nerves at the root entry/exit zone. Clinically, we can distinguish the following NVC conditions: trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. Also, rare cases of geniculate neuralgia and superior laryngeal neuralgia are reported. Other syndromes, e.g., disabling positional vertigo, arterial hypertension in the course of NVC at the CN IX-X REZ and torticollis, have insufficient clinical evidence for microvascular decompression. The exact pathomechanism leading to characteristic NVC-related symptoms remains unclear. Proposed etiologies have limited explanatory scope. Therefore, we have examined the underlying pathomechanisms stated in the medical literature. To achieve our goal, we systematically reviewed original English language papers available in Pubmed and Web of Science databases before 2 October 2021. We obtained 1694 papers after eliminating duplicates. Only 357 original papers potentially pertaining to the pathogenesis of NVC were enrolled in full-text assessment for eligibility. Of these, 63 were included in the final analysis. The systematic review suggests that the anatomical and/or hemodynamical changes described are insufficient to account for NVC-related symptoms by themselves. They must coexist with additional changes such as factors associated with the affected nerve (e.g., demyelination, REZ modeling, vasculature pathology), nucleus hyperexcitability, white and/or gray matter changes in the brain, or disturbances in ion channels. Moreover, the effects of inflammatory background, altered proteome, and biochemical parameters on symptomatic NVC cannot be ignored. Further studies are needed to gain better insight into NVC pathophysiology.
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Affiliation(s)
- Bartosz Szmyd
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, Lodz, Poland
| | - Julia Sołek
- Department of Pathology, Chair of Oncology, Medical University of Lodz, Lodz, Poland
| | - Maciej Błaszczyk
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, Lodz, Poland
| | - Jakub Jankowski
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, Lodz, Poland
| | - Paweł P. Liberski
- Department of Molecular Pathology and Neuropathology, Medical University of Lodz, Lodz, Poland
| | - Dariusz J. Jaskólski
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland
| | - Filip F. Karuga
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Marcin Sochal
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, United States
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- University of Queensland, Brisbane, QLD, Australia
| | - Maciej Radek
- Department of Neurosurgery, Spine and Peripheral Nerve Surgery, Medical University of Lodz, Lodz, Poland
- *Correspondence: Maciej Radek
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Sekhar LN, Shenoy VS, Holdefer R, White M. Commentary: A Novel Approach to Microvascular Decompression for Hemifacial Spasm: Method Description and Associated Outcomes. Oper Neurosurg (Hagerstown) 2022; 23:e23-e25. [PMID: 35726931 DOI: 10.1227/ons.0000000000000263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Laligam N Sekhar
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Robert Holdefer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Melodie White
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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11
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Valente Aguiar P, Silveira F, Vaz R, Linhares P, Pereira P. Perineal and foot muscle synkinesis following trauma to the sacrum in an adult male - A case of motor root ephaptic transmission? Clin Neurol Neurosurg 2022; 219:107340. [PMID: 35716456 DOI: 10.1016/j.clineuro.2022.107340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/04/2022] [Accepted: 06/12/2022] [Indexed: 11/03/2022]
Abstract
Ephaptic transmission has been proven as an alternative to chemical synaptic neural transmission and occurs in pathological situations, such as epilepsy and demyelination. Hereby, we report the case of an adult male that in 2012 was involved in a low-speed motorcycle accident with sacrum impact that from day three onwards reported unwanted penile movement when performing hallux and toe plantar flexion of the right foot. Urologic studies and perineal MRI were unremarkable but sacral MRI showed a significantly stenotic canal at the S1-S2 level while EMG displayed chronic moderate right S2 radiculopathy. Nine years later the patient underwent surgical decompression of the sacral canal with complete resolution of the synkinesis. We hypothesize ephaptic transmission between adjacent motor nerve fibres at the S2 sacral nerve root to be the likely mechanism explaining this phenomenon.
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Affiliation(s)
- Pedro Valente Aguiar
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Fernando Silveira
- Neurology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rui Vaz
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Neurosciences Centre, Hospital CUF Porto, Portugal
| | - Paulo Linhares
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Neurosciences Centre, Hospital CUF Porto, Portugal
| | - Paulo Pereira
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Neurosciences Centre, Hospital CUF Porto, Portugal
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12
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New Technology: Compound Abnormal Muscle Response During Microvascular Decompression for Hemifacial Spasm. J Craniofac Surg 2022; 33:e283-e285. [DOI: 10.1097/scs.0000000000008143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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13
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Zhang J, Yu Q, Gu P, Sun H, Yuan F, Zhang Q. Brain Structure Alterations in Hemifacial Spasm: A Diffusion Tensor Imaging Study. Clin EEG Neurosci 2022; 53:165-172. [PMID: 33289577 DOI: 10.1177/1550059420979250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined white matter integrity in patients with left-sided hemifacial spasm (HFS) using diffusion tensor imaging (DTI). Thirty-six patients with left-sided HFS (mean age 53.24 ± 8.16 years) and 36 healthy volunteers (mean age 53.92 ± 7.73 years) were recruited. Tract-based spatial statistics (TBSS) analysis revealed significantly increased fractional anisotropy (FA) of bilateral superior longitudinal fasciculus in HFS patients (P < 0.05, family-wise error corrected), with trends for radial diffusivity to decrease. We inferred that the results may be associated with poor sleep quality, impairment in visuospatial construction, and activity-dependent increases in myelination in HFS patients. Furthermore, the FA value of left superior longitudinal fasciculus showed a positive correlation with HFS duration (r = 0.352, P = .041) and spasm severity (r = 0.416, P = .014). However, the alteration of medial diffusivity and axial diffusivity were not found in bilateral superior longitudinal fasciculus between groups. These findings suggest FA changes of superior longitudinal fasciculus reflected by TBSS analysis may provide valuable insights into the diagnosis of HFS.
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Affiliation(s)
- Jian Zhang
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury and Neuroscience, Characteristic Medical Center of Chinese People's Armed Police Forces, Dongli District, Tianjin, China.,Logistics University of People's Armed Police Force, Tianjin, China
| | - Qingyang Yu
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury and Neuroscience, Characteristic Medical Center of Chinese People's Armed Police Forces, Dongli District, Tianjin, China.,Department of Radiology, Characteristic Medical Center of Chinese People's Armed Police Forces, Dongli District, Tianjin, China
| | - Peng Gu
- Department of Radiology, Characteristic Medical Center of Chinese People's Armed Police Forces, Dongli District, Tianjin, China
| | - Hongtao Sun
- Logistics University of People's Armed Police Force, Tianjin, China
| | - Fei Yuan
- Department of Radiology, Characteristic Medical Center of Chinese People's Armed Police Forces, Dongli District, Tianjin, China
| | - Quan Zhang
- Department of Radiology, Characteristic Medical Center of Chinese People's Armed Police Forces, Dongli District, Tianjin, China
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14
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Predicting Early Loss of Lateral Spread Response before Decompression in Hemifacial Spasm Surgery. LIFE (BASEL, SWITZERLAND) 2021; 12:life12010040. [PMID: 35054433 PMCID: PMC8779050 DOI: 10.3390/life12010040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022]
Abstract
Recent studies have shown the evocation of lateral spread response (LSR) due to the compression of the facial nerve in hemifacial spasm (HFS). Intraoperative monitoring (IOM) of LSR could help locate neurovascular conflicts and confirm adequate micro-vascular decompression (MVD) while treatment of hemifacial spasm (HFS). However, studies on early LSR loss before decompression in HFS surgery are sparse, indicating the need to understand various perceptions on it. Therefore, we retrospectively analyzed 50 adult HFS patients who underwent MVD during the period of September 2018–June 2021. We employed IOM combining traditional LSR (tLSR) and dual LSR (dLSR). One patient was excluded owing to the lack of LSR induction throughout the surgery, while 49 were divided into groups A (n = 14) and B (n = 35), designated as with or without early LSR loss groups, respectively, and offending vessels were analyzed. The mean age of group A patients was significantly younger (47.8 ± 8.6) than that of group B (53.9 ± 10.6) (p = 0.0393). The significant predominating offending vessel in group A was the anterior inferior cerebellar artery (AICA, 78.57%). However, group B included those with AICA (28.57%), posterior inferior cerebellar artery (PICA, 22.86%), vertebral artery (VA) involved (25.71%), and combined AICA and PICA (22.86%). Group B exhibited poorer clinical outcomes with more complications. Conclusively, early LSR loss might occur in the younger population, possibly due to the AICA offending vessel. The compression severity of offending vessels may determine the occurrence of early LSR loss.
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15
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Ding YQ, Qi JG. Sensory root demyelination: Transforming touch into pain. Glia 2021; 70:397-413. [PMID: 34549463 DOI: 10.1002/glia.24097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/12/2022]
Abstract
The normal feeling of touch is vital for nearly every aspect of our daily life. However, touching is not always felt as touch, but also abnormally as pain under numerous diseased conditions. For either mechanistic understanding of the faithful feeling of touch or clinical management of chronic pain, there is an essential need to thoroughly dissect the neuropathological changes that lead to painful touch or tactile allodynia and their corresponding cellular and molecular underpinnings. In recent years, we have seen remarkable progress in our understanding of the neural circuits for painful touch, with an increasing emphasis on the upstream roles of non-neuronal cells. As a highly specialized form of axon ensheathment by glial cells in jawed vertebrates, myelin sheaths not only mediate their outstanding neural functions via saltatory impulse propagation of temporal and spatial precision, but also support long-term neuronal/axonal integrity via metabolic and neurotrophic coupling. Therefore, myelinopathies have been implicated in diverse neuropsychiatric diseases, which are traditionally recognized as a result of the dysfunctions of neural circuits. However, whether myelinopathies can transform touch into pain remains a long-standing question. By summarizing and reframing the fragmentary but accumulating evidence so far, the present review indicates that sensory root demyelination represents a hitherto underappreciated neuropathological change for most neuropathic conditions of painful touch and offers an insightful window into faithful tactile sensation as well as a potential therapeutic target for intractable painful touch.
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Affiliation(s)
- You-Quan Ding
- Department of Histology, Embryology and Neurobiology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Guo Qi
- Department of Histology, Embryology and Neurobiology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
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16
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Shingai Y, Endo H, Endo T, Osawa SI, Nizuma K, Tominaga T. Ocular neuromyotonia caused by a recurrent sphenoidal ridge meningioma. Surg Neurol Int 2021; 12:219. [PMID: 34084646 PMCID: PMC8168646 DOI: 10.25259/sni_38_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/15/2021] [Indexed: 11/04/2022] Open
Abstract
Background Ocular neuromyotonia (ONM) is a rare ocular motility disorder characterized by involuntary paroxysmal extraocular muscle contraction and is caused by radiation therapy, vascular compression, and inflammatory disease. This study includes a rare case of ONM caused by a recurrent meningioma. Case Description A 56-year-old man presented with diplopia due to the right oculomotor nerve palsy caused by a sphenoidal atypical meningioma, with improved symptoms after initial surgery. During the next 7 years, he underwent local radiation therapy, second surgery, and Gamma Knife radiosurgery to control the tumor's repetitive recurrence around the right anterior clinoid process. After these treatments, residual tumor was controlled for the next 3 years. However, 3 months after his last visit, he started to suffer from the right ONM and visual disturbance. The magnetic resonance imaging results revealed a rapid growth of the posterior part of the residual tumor, involving the right oculomotor nerve. The third tumor resection was performed to prevent further aggravation of the symptoms. Decompression of the right oculomotor nerve was achieved, and ONM disappeared immediately after surgery. Conclusion If nerve compression by the tumor is clearly indicated with the neuroradiological assessment, surgical intervention is the treatment of choice to improve ONM.
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Affiliation(s)
- Yuto Shingai
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan.,Department of Neurosurgery, Kohnan Hospital, , Tohoku University, Sendai, Miyagi, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Kuniyasu Nizuma
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, , Tohoku University, Sendai, Miyagi, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
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17
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Affiliation(s)
- Subahari Raviskanthan
- Neuro-Ophthalmology Fellow, Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Peter W Mortensen
- Neuro-Ophthalmology Fellow, Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Andrew Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, University of Texas MD Anderson Cancer Center, Houston, Texas, Texas A and M College of Medicine, Bryan, Texas, Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
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18
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Nugroho SW, Perkasa SAH, Gunawan K, Manuhutu YN, Rahman MA, Rizky A. Predicting outcome of hemifacial spasm after microvascular decompression with intraoperative monitoring: A systematic review. Heliyon 2021; 7:e06115. [PMID: 33644443 PMCID: PMC7889992 DOI: 10.1016/j.heliyon.2021.e06115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/07/2020] [Accepted: 01/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Microvascular decompression has been established as a primary treatment for hemifacial spasm. Intraoperative monitoring is used during the surgery to guide neurosurgeons to determine whether the decompression of facial nerve from the vessel is sufficient. We performed a systematic review to assess the role of lateral spread response (LSR) monitoring in predicting hemifacial spasm outcomes after microvascular decompression. METHOD A systematic search of PubMed, ScienceDirect, Cochrane, and Google Scholar was conducted. We included studies that performed microvascular decompression surgery with intraoperative monitoring analyzing the correlation between lateral spread response and spasm relief. A critical appraisal was conducted for selected studies. RESULT Twenty-two studies comprising 6404 cases of hemifacial spasm, which underwent microvascular decompression surgery with intraoperative monitoring, were included. Of 15 articles that assessed symptoms shortly after surgery, 12 studies showed a significant correlation between lateral spread response resolution and disappearance of spasm. Four of six studies that evaluated the outcome at 3-month follow-up showed significant relationship between LSR and outcome, so did five of six articles that assessed spasm relief at 6-month follow-up. As much as 62.5% of studies (10 of 16) showed the result at long-term follow-up (≥1-year) was not significant. CONCLUSION Intraoperative monitoring during microvascular decompression surgery can be a useful tool to predict hemifacial spasm resolution. Though long-term outcomes of patients with LSR relief and persistence are similar, resolution of symptoms shortly after surgery will provide comfort to patients thereby improving their quality of life.
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Affiliation(s)
- Setyo Widi Nugroho
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
| | - Sayyid Abdil Hakam Perkasa
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
| | - Kevin Gunawan
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
| | - Yovanka Naryai Manuhutu
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
| | - Muhamad Aulia Rahman
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
| | - Amal Rizky
- Neurofunctional Division, Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Indonesia
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19
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Murase N, Goto M, Kohara N, Kimura J. Sustained atypical myokymia of the abductor pollicis brevis with a focal slowing of the median nerve motor axons at the wrist. Clin Neurophysiol Pract 2020; 6:36-40. [PMID: 33490741 PMCID: PMC7808925 DOI: 10.1016/j.cnp.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 11/15/2020] [Accepted: 11/26/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We report a case of sustained atypical myokymia associated with short bursts of neuromyotonic discharges involving the abductor pollicis brevis (APB) muscle and describe a useful way of detecting a focal slowing involving a small number of median nerve motor fibers with a concentric needle using the filter setting for single fiber electromyography (EMG). METHODS AND RESULTS A 62-year-old woman developed right thumb twitches at regular interval of 1.7-3.3 s (0.6-0.3 Hz), which continued for more than four months. Muscle twitches remained the same during altered hand position, psychological stress, or sleep. A concentric needle inserted in the active zone of the APB muscle revealed myokymic bursts with a characteristic of neuromyotonic discharges. Inching study, stimulating at 5 mm increment along the median nerve and recording with a concentric needle using a filter setting for single fiber EMG, revealed a focal slowing of the motor fibers at a point 5-10 mm distal from the distal crease of the wrist, an entrapment site occasionally seen in the carpal tunnel syndrome. One injection of botulinum toxin type A eliminated the myokymia, which then recurred two and a half years later, showing less prominent muscle twitches. CONCLUSIONS Sustained atypical myokymia seen in our case represented bursts of neuromyotonic discharges originated from a focal demyelinating lesion involving a few median nerve motor fibers.
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Affiliation(s)
- Nagako Murase
- Department of Neurology, National Hospital Organization, Kyoto Medical Center, 1-1 Mukoubata-cho, Fukakusa, Fushimi-ku, Kyoto City, Kyoto 612-8555, Japan
| | - Masahiro Goto
- Department of Neurology, National Hospital Organization, Kyoto Medical Center, 1-1 Mukoubata-cho, Fukakusa, Fushimi-ku, Kyoto City, Kyoto 612-8555, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, 1-1, 2 cho-me, Minamimachi, Minatojima, Chuou-ku, Kobe City, Kobe 650-0047, Japan
| | - Jun Kimura
- Department of Neurology, Division of Clinical Neurophysiology, University of Iowa Health Center, 200 Hawkins Drive, Iowa City, IA 52242, USA
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20
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Kim M, Park SK, Lee S, Lee JA, Park K. Letter: The Utility of Intraoperative Lateral Spread Recording in Microvascular Decompression for Hemifacial Spasm: A Systematic Review and Meta-Analysis. Neurosurgery 2020; 87:E596-E597. [PMID: 32761204 DOI: 10.1093/neuros/nyaa339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Minsoo Kim
- Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, Korea
- Department of Medicine Graduate School Yonsei University College of Medicine Seoul, Korea
| | - Sang-Ku Park
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, Korea
| | - Seunghoon Lee
- Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, Korea
| | - Jeong-A Lee
- Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, Korea
| | - Kwan Park
- Department of Neurosurgery Samsung Medical Center Sungkyunkwan University School of Medicine Seoul, Korea
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21
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Predictive value of intraoperative blink reflex monitoring for surgical outcome during microvascular decompression for hemifacial spasm. Clin Neurophysiol 2020; 131:2268-2275. [DOI: 10.1016/j.clinph.2020.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/21/2020] [Accepted: 06/13/2020] [Indexed: 11/17/2022]
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22
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Heffez DS, Golchini R, Ghorai J, Cohen B. Operative findings and surgical outcomes in patients undergoing Chiari 1 malformation decompression: relationship to the extent of tonsillar ectopia. Acta Neurochir (Wien) 2020; 162:1539-1547. [PMID: 31873790 DOI: 10.1007/s00701-019-04172-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 12/10/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The diagnosis of Chiari 1 malformation is based on the extent of tonsillar ectopia. OBJECTIVE To examine the relationship between the extent of tonsillar ectopia and the intra-operative findings and clinical outcome following Chiari decompression surgery. METHODS Patients were divided into four groups depending on the position of the cerebellar tonsil (T): group 1: 0 < T < 3; group 2: 3 ≤ T ≤ 5; group 3: 5 < T ≤ 10; and group 4: T > 10. Intra-operative observations were recorded with regard to compression of the brain stem by posterior inferior cerebellar artery (pica), neuroma formation along the first cervical (C1), and accessory spinal nerves (XI), and pallor of the cerebellar tonsils. Brain stem auditory evoked potentials, (BAEP), were monitored in each case. One hundred sixty-eight patients accrued between 2009 and 2013 agreed to participate in an outcome study to determine the effectiveness of foramen magnum decompression. Findings across the four groups were compared using one-way ANOVA. Observed differences were further subjected to paired analysis. Intra-group comparisons were made using the paired t test. A P value less than 0.05 was considered statistically significant. RESULTS There were 98 patients in group 1, 147 patients in group 2, 180 patients in group 3, and 63 patients in group 4. The mean extent of tonsillar ectopia was 0.4, 4.0, 7.1, and 14.3 mm in the four groups respectively. The prevalence of tonsillar pallor was greatest in group 4. Otherwise, there was no difference observed in the operative findings. A reduction of > 0.1 msec in the wave III-wave V latency of the BAEP was noted in all four groups with equal frequency. One hundred ten patients complied with at least 6 months follow-up. There was no difference in the prevalence of symptoms between the four groups at the time of initial evaluation and at 6 weeks and 6 months following surgery. There was a statistically significant reduction in the intensity of individual symptoms 6 months following surgery regardless of the extent of tonsil ectopia. CONCLUSION Other than the finding of tonsillar pallor, there was no relationship between the extent of tonsillar ectopia and the intraoperative anatomical and physiological observations, nor was there any relationship to the likelihood of symptomatic improvement following surgery. These observations call into question the focus on the extent of tonsillar of ectopia in assessing the patient who presents with symptoms of the Chiari malformation.
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Affiliation(s)
- Dan S Heffez
- Milwaukee Neurological Institute, 960 N 12th ST, Suite 1800, Milwaukee, WI, 53233, USA.
- The Wisconsin Chiari Center, Columbia St. Mary's Hospital, Milwaukee, USA.
| | - Ramin Golchini
- Department of Radiology, Columbia St. Mary's Hospital, Milwaukee, WI, USA
| | - Jugal Ghorai
- Department of Mathematics, University of Wisconsin, Milwaukee, USA
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23
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Holste K, Sahyouni R, Teton Z, Chan AY, Englot DJ, Rolston JD. Spasm Freedom Following Microvascular Decompression for Hemifacial Spasm: Systematic Review and Meta-Analysis. World Neurosurg 2020; 139:e383-e390. [PMID: 32305605 PMCID: PMC7899163 DOI: 10.1016/j.wneu.2020.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hemifacial spasm (HFS) is a debilitating disorder characterized by intermittent involuntary movement of muscles innervated by the facial nerve. HFS is caused by neurovascular compression along the facial nerve root exit zone and can be treated by microvascular decompression (MVD). The goal was to determine rates and predictors of spasm freedom after MVD for HFS. METHODS A literature search using the key terms "microvascular decompression" and "hemifacial spasm" was performed. The primary outcome variable was spasm freedom at last follow-up. Analysis was completed to evaluate for variables associated with spasm-free outcome. RESULTS A total of 39 studies including 6249 patients were analyzed. Overall spasm freedom rate was 90.5% (5652/6249) at a follow-up of 1.25 ± 0.04 years. There was no significant relationship between spasm freedom versus persistent spasm and age at surgery, timing of follow-up, gender, disease duration, side of disease, or vessel type. Spasm freedom was more likely after an initial surgery versus a redo MVD (odds ratio 4.16, 95% confidence interval 1.99-8.68; P < 0.01). CONCLUSIONS MVD works well for HFS with cure rates >90% at 1-year follow-up in 6249 patients from 39 studies. A significant predictor of long-term spasm freedom at 1 year was an initial MVD as compared to repeat MVD. The majority of published manuscripts on MVD for HFS are heterogeneous single-institutional retrospective studies. As such, a large-scale meta-analysis reporting outcome rates and evaluating significant predictors of spasm freedom provides utility in the absence of randomized controlled studies.
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Affiliation(s)
- Katherine Holste
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Zoe Teton
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Alvin Y Chan
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
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24
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Thirumala PD, Altibi AM, Chang R, Saca EE, Iyengar P, Reddy R, Anetakis K, Crammond DJ, Balzer JR, Sekula RF. The Utility of Intraoperative Lateral Spread Recording in Microvascular Decompression for Hemifacial Spasm: A Systematic Review and Meta-Analysis. Neurosurgery 2020; 87:E473-E484. [DOI: 10.1093/neuros/nyaa069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/30/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Microvascular decompression (MVD) is the surgical treatment of choice for hemifacial spasm (HFS). During MVD, monitoring of the abnormal lateral spread response (LSR), an evoked response to facial nerve stimulation, has been traditionally used to monitor adequacy of cranial nerve (CN) VII decompression.
OBJECTIVE
To assess the utility of LSR monitoring in predicting spasm-free status after MVD postoperatively.
METHODS
We searched PubMed, Web of Science, and Embase for relevant publications. We included studies reporting on intraoperative LSR monitoring during MVD for HFS and spasm-free status following the procedure. Sensitivity of LSR, specificity, diagnostic odds ratio, and positive predictive value were calculated.
RESULTS
From 148 studies, 26 studies with 7479 patients were ultimately included in this meta-analysis. The final intraoperative LSR status predicted the clinical outcome of MVD with the following specificities and sensitivities: 89% (0.83- 0.93) and 40% (0.30- 0.51) at discharge, 90% (0.84-0.94) and 41% (0.29-0.53) at 3 mo, 89% (0.83-0.93) and 40% (0.30-0.51) at 1 yr. When LSR persisted after MVD, the probability (95% CI) for HFS persistence was 47.8% (0.33-0.63) at discharge, 40.8% (0.23-0.61) at 3 mo, and 24.4% (0.13-0.41) at 1 yr. However, when LSR resolved, the probability for HFS persistence was 7.3% at discharge, 4.2% at 3 mo, and 4.0% at 1 yr.
CONCLUSION
Intraoperative LSR monitoring has high specificity but modest sensitivity in predicting the spasm-free status following MVD. Persistence of LSR carries high risk for immediate and long-term facial spasm persistence. Therefore, adequacy of decompression should be thoroughly investigated before closing in cases where intraoperative LSR persists.
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Affiliation(s)
- Parthasarathy D Thirumala
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ahmed M Altibi
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert Chang
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eyad E Saca
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pragnya Iyengar
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rajiv Reddy
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katherine Anetakis
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Donald J Crammond
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jeffrey R Balzer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Using strength-duration analysis to identify the afferent limb of the lateral spread response in hemifacial spasm patients during microvascular decompression surgery. J Clin Neurosci 2020; 74:6-10. [PMID: 31973918 DOI: 10.1016/j.jocn.2020.01.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/13/2020] [Indexed: 11/24/2022]
Abstract
Strength-duration analysis has been used to identify excitability differences between motor and sensory axons in human peripheral mixed nerves. The trigeminal and facial nerves have both been suggested to play a role in mediating the lateral spread response (LSR) in patients with hemifacial spasm (HFS). We sought to investigate this hypothesis by analyzing strength-duration properties of spasm side mentalis M wave and o. oculi LSR in 22 patients undergoing microvascular decompression surgery for HFS. Simultaneous recordings of mentalis M wave and o. oculi LSR prior to dural opening were collected following marginal mandibular facial nerve branch stimulation. Threshold responses were observed at stimulus pulse widths from 0.05 to 1.0 ms and the chronaxie and rheobase calculated from charge versus stimulus pulse width plots. The mean chronaxie (±SEM) of mentalis M wave was 0.34 ± 0.03 ms and 0.33 ± 0.04 ms for the LSR (p = 0.42, one-tailed t-test). The rheobase for the M wave (8.0 ± 1.0 mA) was found to be significantly different than the LSR rheobase (5.7 ± 0.7 mA; p = 0.03, one-tailed t-test) likely due to differences in the threshold amplitudes of the M wave versus the LSR. These results are highly suggestive of the facial nerve and not the trigeminal nerve in mediating the LSR.
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26
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Park SK, Joo BE, Park K. Intraoperative Neurophysiological Monitoring during Microvascular Decompression Surgery for Hemifacial Spasm. J Korean Neurosurg Soc 2019; 62:367-375. [PMID: 31290293 PMCID: PMC6616990 DOI: 10.3340/jkns.2018.0218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/04/2019] [Indexed: 12/02/2022] Open
Abstract
Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.
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Affiliation(s)
- Sang-Ku Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Euk Joo
- Department of Neurology, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea
| | - Kwan Park
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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27
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Song H, Xu S, Fan X, Yu M, Feng J, Sun L. Prognostic value of lateral spread response during microvascular decompression for hemifacial spasm. J Int Med Res 2019; 47:6120-6128. [PMID: 30982379 PMCID: PMC7045667 DOI: 10.1177/0300060519839526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective This study aimed to investigate the prognostic value of the lateral spread response (LSR) for predicting surgical outcomes following microvascular decompression (MVD) in patients with hemifacial spasm. Methods Seventy-three patients with hemifacial spasm underwent MVD with intraoperative LSR monitoring. Surgical outcomes were evaluated 1 week and 1 year after MVD and correlations between LSR characteristics and surgical outcomes were analyzed. Results The LSR disappeared completely in 61 patients during surgery (Group A; prior to insertion of Teflon felt pledgets in 11, after insertion of pledgets in 50), disappeared partially in nine patients (Group B), and remained unchanged in three patients (Group C). Fifty-five patients showed short-term and 61 patients showed long-term clinical cures during the follow-up period. The short-term and long-term cure rates were significantly higher in Group A than in Group C. There was no correlation between the time of complete LSR disappearance and surgical outcomes. Conclusions Disappearance of the LSR during MVD is correlated with the surgical outcomes. Intraoperative LSR monitoring is a reliable approach for predicting the prognosis of hemifacial spasm following MVD, but the time at which LSR disappears is not a prognostic indicator.
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Affiliation(s)
- Hongmei Song
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Songbai Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiushuang Fan
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Mingxin Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jiachun Feng
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lichao Sun
- Department of Emergency Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
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A Rare Potential Compression Can Be Avoided by Lateral Spread Response Recordings During Microvascular Decompression for Hemifacial Spasm. J Craniofac Surg 2019; 30:e501-e503. [PMID: 30921064 DOI: 10.1097/scs.0000000000005400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The authors report a 34-year-old female with hemifacial spasm who was identified as a candidate for microvascular decompression. Lateral spread response (LSR) was not recorded at first because of anatomical shift of neurovascular relationship after drainage of cerebrospinal fluid, but they reappeared only after a piece of shredded gelatin sponge was placed near the posteroinferior cerebellar artery to expand surgical field. As the authors removed the gelatin sponge, the LSRs disappeared instantly. Subsequently, the authors put some soft shredded Teflon between the offending vessel and brainstem. Since then the authors did not find LSRs anymore. Clinical follow-up had been carried out with a questionnaire from 1 week to 3 months postoperatively, and the patient was cured with no complications. This report presented that the gelatin sponge placed in an inappropriate position resulting in compression potentially leading to the opposite effect of treatment. Such kind of excessive operation could be avoided by electrophysiological monitoring.
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Abstract
Late responses include F waves, A waves, H reflex, and the blink reflex. These responses help enhance routine nerve conduction studies. Despite the use of F waves in multiple clinical applications, their studies can technically challenge even the most experienced electromyographers. They vary in latency, amplitude, and configuration, whereas A waves show no change in latency or morphology. Electrical stimulation of the supraorbital branch of the trigeminal nerve on one side results in a reflexive activation of the facial nucleus causing contraction of the orbicularis oculi muscle, short latency R1 ipsilaterally, and long latency R2 bilaterally. F waves can help determine the presence of a polyneuropathy. A waves can reflect axonal damage. H reflexes provide nerve conduction measurements along the entire length of the nerve, demonstrating abnormalities in neuropathies and radiculopathies. Abnormalities in the blink reflex can suggest the presence of an acoustic neuroma or a demyelinating polyneuropathy, which can affect the cranial nerves. This reflex, which also needs appropriate technical expertise, helps to assess cranial nerves V and VII along with their connections in the pons and medulla. The blink reflex, the electrical version of the corneal reflex, represents a polysynaptic reflex.
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Affiliation(s)
- Nivedita Jerath
- Department of Neurology, University of Iowa, Iowa City, IA, United States.
| | - Jun Kimura
- Department of Neurology, University of Iowa, Iowa City, IA, United States
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Abstract
OPINION STATEMENT The treatment of both hemifacial spasm (HFS) and blepharospasm (BEB) requires making the appropriate clinical diagnosis. Advance imaging and electrophysiologic studies are useful; however, one's clinical suspicion is paramount. The purpose of this review is to summarize current and emerging therapies for both entities. Botulinum toxin (BTX) remains the first-line therapy to treat both conditions. If chemodenervation has failed, surgery may be considered. Due to the risks associated with surgery, the benefits of this option must be carefully weighed. Better surgical outcomes are possible when procedures are performed at tertiary centers with experienced surgeons and advanced imaging techniques. Microvascular decompression is an efficacious method to treat HFS, and myectomy is an option for medication-refractory BEB; the risks of the latter may outweigh any meaningful clinical benefits. Oral agents only provide short-term relief and can cause several unwanted effects; they are reserved for patients who cannot receive BTX and/or surgery. Transcranial magnetic stimulation has gained some traction in the treatment of BEB and may provide safer non-invasive options for refractory patients in the future.
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Affiliation(s)
- Kemar E Green
- Departments of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA.
| | - David Rastall
- Michigan State University, College of Osteopathic Medicine, East Lansing, MI, USA
| | - Eric Eggenberger
- Departments of Ophthalmology and Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
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Jiang C, Xu W, Dai Y, Lu T, Jin W, Liang W. Early permanent disappearance of abnormal muscle response during microvascular decompression for hemifacial spasm: a retrospective clinical study. Neurosurg Rev 2016; 40:479-484. [DOI: 10.1007/s10143-016-0805-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/19/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
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Reply to “The origin of the abnormal muscle response seen in hemifacial spasm remains controversial”. Clin Neurophysiol 2016; 127:2706-7. [DOI: 10.1016/j.clinph.2016.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 11/18/2022]
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Kaufmann AM, Wilkinson MF. The origin of the abnormal muscle response seen in hemifacial spasm remains controversial. Clin Neurophysiol 2016; 127:2704-5. [PMID: 27222310 DOI: 10.1016/j.clinph.2016.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/02/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Anthony M Kaufmann
- Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Marshall F Wilkinson
- Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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