Acta Neurochirurgica

, Volume 160, Issue 5, pp 963–970 | Cite as

Intraoperative monitoring of Z-L response (ZLR) and abnormal muscle response (AMR) during microvascular decompression for hemifacial spasm. Interpreting the role of ZLR

Original Article - Functional
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Abstract

Background

Z-L response (ZLR) has been suggested to a new electromyographic (EMG) potential recorded from the facial muscle of patient with hemifacial spasm (HFS) during microvascular decompression (MVD). Although ZLR has been suggested to be useful, experience of ZLR monitoring is limited and its significance during MVD is still unclear.

Methods

To investigate the significance of ZLR, both ZLR and abnormal muscle response (AMR) were simultaneously recorded before and after decompression of root exit zone (REZ) in 20 consecutive patients with HFS.

Results

All 19 AMRs elicited before REZ decompression disappeared immediately after decompression of REZ. ZLRs were also observed before decompression of REZ in 19 (95%) of 20 patients. Despite negative conversion of AMR after decompression in 19 patients, ZLR disappeared in only 13 (68.4%) of 19 patients. Among six sustained ZLRs, three showed reduction in the intensity of ZLRs while the other three remained unchanged. There were nine cases featuring attachment of the distal, non-offending portion of offending vessels to the distal course of the facial nerve in addition to attachment to REZ. Negative ZLR conversion and presence of peripheral contact of offending vessels to distal facial nerves showed significant correlations (p < 0.05). ZLR could be elicited by electrical stimulation at non-REZ-offending portion of the offending arterial wall, attached to the distal course of the facial nerve. HFS disappeared immediately in all 20 patients.

Conclusions

Although ZLR might be helpful in cases with multiple offenders, interpretation of ZLR needs caution for non-specific transmission of electric current through vessel wall to facial nerve.

Keywords

Abnormal muscle response Hemifacial spasm Microvascular decompression Z-L response 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with ethical standards of the institutional and/or National Research Committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of retrospective study, formal consent was not required.

References

  1. 1.
    Barker FG II, Jannetta PJ, Bisonette DJ, Shields PT, Larkins MV, Jho HD (1995) Microvascular decompression for hemifacial spasm. J Neurosurg 82:201–210CrossRefPubMedGoogle Scholar
  2. 2.
    Campos-Benitez M, Kaufmann AM (2008) Neurovascular compression findings in hemifacial spasm. J Neurosurg 109:416–420CrossRefPubMedGoogle Scholar
  3. 3.
    De Ridder D, Møller A, Verlooy J, Cornelissen M, De Ridder L (2002) Is the root entry/exit zone important in microvascular compression syndrome? Neurosurgery 51:427–433CrossRefPubMedGoogle Scholar
  4. 4.
    Fernández-Conejero I, Ulkatan S, Sen C, Deletis V (2012) Intra-operative neurophysiology during microvascular decompression for hemifacial spasm. Clin Neurophysiol 123:78–83CrossRefPubMedGoogle Scholar
  5. 5.
    Hyun SJ, Kong DS, Park K (2010) Microvascular decompression for treating hemifacial spasm: lesion learned from a prospective study of 1,174 operations. Neurosurg Rev 33:325–334CrossRefPubMedGoogle Scholar
  6. 6.
    Kawashima M, Yamada M, Sato S, Oka H, Fujii K, Matsushima T (2009) Hemifacial spasm caused by vascular compression of the distal portion of the facial nerve associated with configuration variation of the facial and vestibulocochlear nerve complex. Turk Neurosurg 19:269–275PubMedGoogle Scholar
  7. 7.
    Kim CH, Kong DS, Lee JA, Park K (2010) The potential value of the disappearance of the lateral spread response during microvascular decompression for predicting the clinical outcome of hemifacial spams: a prospective study. Neurosurgery 67:1581–1588CrossRefGoogle Scholar
  8. 8.
    Kiya N, Bannur T, Yamaguchi A, Yoshida K, Kato Y, Kanno T (2001) Monitoring of facial evoked EMG for hemifacial spasm: a critical analysis of its prognostic value. Acta Neurochir 143:365–368CrossRefPubMedGoogle Scholar
  9. 9.
    Kondo A (1997) Follow-up results of microvascular decompression in trigeminal neuralgia and hemifacial spasm. Neurosurgery 40:46–51PubMedGoogle Scholar
  10. 10.
    Kong DS, Park K, Shin BG, Lee JA, Eum DO (2007) Prognostic value of the lateral spread response for intraoperative electromyography monitoring of the facial musculature during microvascular decompression for hemifacial spasm. J Neurosurg 106:384–387CrossRefPubMedGoogle Scholar
  11. 11.
    Li S, Hong W, Tang Y, Ying T, Zhang W, Li X, Zhu J, Zhong K, Hua X, Xu S, Wan L, Wang X, Yang M, Li Y, Zheng X (2010) Re-operation for persistent hemifacial spasm after microvascular decompression with the aid of intraoperative monitoring of abnormal muscle response. Acta Neurochir 152:2113–2118CrossRefPubMedGoogle Scholar
  12. 12.
    McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK (1999) Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90:1–8CrossRefPubMedGoogle Scholar
  13. 13.
    Mooij JJ, Mustafa MK, van Weerden TW (2001) Hemifacial spasm: intraoperative electromyographic monitoring as a guide for microvascular decompression. Neurosurgery 49:1365–1371CrossRefPubMedGoogle Scholar
  14. 14.
    Møller AR (1999) Vascular compression of cranial nerves II. Pathophysiology. Neurol Res 21:439–443PubMedGoogle Scholar
  15. 15.
    Møller AR, Jannetta PJ (1985) Microvascular decompression in hemifacial spasm: intraoperative electrophysiological observations. Neurosurgery 16:612–618CrossRefPubMedGoogle Scholar
  16. 16.
    Møller AR, Møller MB (2007) Microvascular decompression operations. Prog Brain Res 166:397–400CrossRefPubMedGoogle Scholar
  17. 17.
    Ryu H, Yamamoto S, Sugiyama K, Uemura K, Miyamoto T (1998) Hemifacial spasm caused by vascular compression of the distal portion of the facial nerve. Report of seven cases. J Neurosurg 88:605–609CrossRefPubMedGoogle Scholar
  18. 18.
    Sekular RF Jr, Bhatia S, Frederickson AM, Jannetta PR, Quigley MR, Small GA, Breisinger R (2009) Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis. Neurosurg Focus 25:E10Google Scholar
  19. 19.
    Shimizu K, Matsumoto M, Wada A, Sugiyama T, Tanioka D, Okumura H, Fujishima H, Nakajo T, Nakayama S, Yabuzaki H, Mizutani T (2015) Supine no-retractor method in microvascular decompression for hemifacial spasm: results of 100 consecutive operations. J Neurol Surg B Skull Base 76:202–207CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Sindou MP (2005) Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiologic monitoring. Acta Neurochir 147:1019–1026CrossRefPubMedGoogle Scholar
  21. 21.
    Tobishima H, Hatayama T, Ohkuma H (2014) Relation between the persistence of an abnormal muscle response and the long-term clinical course after microvascular decompression for hemifacial spasm. Neurol Med Chir (Tokyo) 54:474–482CrossRefGoogle Scholar
  22. 22.
    Von Eckardstein K, Harper C, Castner M, Link M (2014) The significance of intraoperative electromyographic “lateral spread” in predicting outcome of microvascular decompression for hemifacial spasm. J Neurol Surg B Skull Base 75:198–203CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Wei Y, Yang W, Zhao W, Pu C, Li N, Cai Y, Shang H (2017) Microvascular decompression for hemifacial spasm: can intraoperative lateral spread response monitoring improve surgical efficacy? J Neurosurg.  https://doi.org/10.3171/2016.11.JNS162148
  24. 24.
    Yang M, Zheng X, Ying T, Zhu J, Zhang W, Yang X, Li S (2014) Combined intraoperative monitoring of abnormal muscle response and Z-L response for hemifacial spasm with tandem compression type. Acta Neurochir 156:1161–1166CrossRefPubMedGoogle Scholar
  25. 25.
    Ying TT, Li ST, Zhong J, Li XY, Wang XH, Zhu J (2011) The value of abnormal muscle response monitoring during microvascular decompression surgery for hemifacial spasm. Int J Surg 9:347–351CrossRefPubMedGoogle Scholar
  26. 26.
    Zheng X, Hong W, Tang Y, Ying T, Wu Z, Shang M, Feng B, Zhang W, Hua X, Zhong J, Li S (2012) Discovery of a new waveform for intraoperative monitoring of hemifacial spasm. Acta Neurochir 154:799–805CrossRefPubMedGoogle Scholar
  27. 27.
    Zhong J, Li ST, Zhu J, Guan HX (2011) Is entire nerve root decompression necessary for hemifacial spasm? Int J Surg 9:254–257CrossRefPubMedGoogle Scholar
  28. 28.
    Zhong J, Zhu J, Li ST, Li XY, Wang XH, Yang M, Wan L, Guan HX (2010) An analysis of failed microvascular decompression in patients with hemifacial spasm: focused on the early reoperative findings. Acta Neurochir 152:2119–2123CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.Catholic Neuroscience Institute, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

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