The lateral spread response (LSR) on preoperative facial electromyogram (EMG) is a useful tool in evaluating patients with hemifacial spasm (HFS). There may be some instances where the LSR does not appear on the preoperative EMG, thus disrupting the diagnosis and treatment of HFS. In this study, we evaluated the patients who did not exhibit LSR on preoperative EMG but underwent microvascular decompression (MVD) for hemifacial spasm. We searched for patients who underwent MVD for HFS but had an absence of LSR on preoperative EMG between January 2016 and June 2018. Surgical outcomes were evaluated at 1, 3, and 6 months after surgery. Follow-up facial EMG was performed 3 months after surgery. Results were divided into two categories: (1) spasm relief within 24 h of surgery and (2) spasm was observed immediately post-operation. The following parameters were analyzed when comparing between the two groups: age, sex, affected side, duration of symptoms, and offending vessel(s). A total of 306 patients underwent MVD for HFS during the study period. Among them, 13 (4.2%) patients had no LSR on preoperative EMG. Eight patients (61.5%) were female and five patients were male. The 13 patients had a mean age of 51 years. All patients exhibited probable offending vessels in the root exit zone (REZ) of the facial nerve on preoperative magnetic resonance (MR) imaging that was confirmed during surgery. Seven patients were free of HFS immediately after surgery, though six patients were not. Only one (7.7%) patient had persisted symptom 6 months after surgery. No patients experienced recurrence of spasm, nor exhibited abnormal waves on follow-up facial EMG. LSR on facial EMG is a valuable tool for evaluating hemifacial spasm. However, although LSR did not appear on preoperative EMG, if the patient presents with typical symptoms and the offending vessels are identified on MRI, we expect good results after MVD for HFS.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Choi SI, Kim MW, Park DY, Huh R, Jang DH (2013) Electrophysiologic investigation during facial motor neuron suppression in patients with hemifacial spasm: possible pathophysiology of hemifacial spasm: a pilot study. Ann Rehabil Med 37:839–847. https://doi.org/10.5535/arm.2013.37.6.839
Chung YH, Kim WH, Lee JJ, Yang SI, Lim SH, Seo DW, Park K, Chung IS (2014) Lateral spread response monitoring during microvascular decompression for hemifacial spasm. Comparison of two targets of partial neuromuscular blockade. Anaesthesist 63:122–128. https://doi.org/10.1007/s00101-013-2286-3
Habeych ME, Shah AC, Nikonow TN, Balzer JR, Crammond DJ, Thirumala PD, Kassam A, Horowitz M (2011) Effect of botulinum neurotoxin treatment in the lateral spread monitoring of microvascular decompression for hemifacial spasm. Muscle Nerve 44:518–524. https://doi.org/10.1002/mus.22104
Ishikawa M, Ohira T, Namiki J, Takase M, Toya S (1994) Neurophysiological study of hemifacial spasm--F wave of the facial muscles. No To Shinkei 46:360–365
Ishikawa M, Namiki J, Takase M, Ohira T, Nakamura A, Toya S (1996) Effect of repetitive stimulation on lateral spreads and F-waves in hemifacial spasm. J Neurol Sci 142:99–106
Ishikawa M, Ohira T, Namiki J, Ajimi Y, Takase M, Toya S (1996) Abnormal muscle response (lateral spread) and F-wave in patients with hemifacial spasm. J Neurol Sci 137:109–116
Ishikawa M, Ohira T, Namiki J, Gotoh K, Takase M, Toya S (1996) Electrophysiological investigation of hemifacial spasm: F-waves of the facial muscles. Acta Neurochir 138:24–32
Isu T, Kamada K, Mabuchi S, Kitaoka A, Ito T, Koiwa M, Abe H (1996) Intra-operative monitoring by facial electromyographic responses during microvascular decompressive surgery for hemifacial spasm. Acta Neurochir 138:19–23 discussion 23
Jo KW, Kong DS, Park K (2013) Microvascular decompression for hemifacial spasm: long-term outcome and prognostic factors, with emphasis on delayed cure. Neurosurg Rev 36:297–301; discussion 301-292. https://doi.org/10.1007/s10143-012-0420-3
Joo WI, Lee KJ, Park HK, Chough CK, Rha HK (2008) Prognostic value of intra-operative lateral spread response monitoring during microvascular decompression in patients with hemifacial spasm. J Clin Neurosci 15:1335–1339. https://doi.org/10.1016/j.jocn.2007.08.008
Kim CH, Kong DS, Lee JA, Kwan P (2010) The potential value of the disappearance of the lateral spread response during microvascular decompression for predicting the clinical outcome of hemifacial spasms: a prospective study. Neurosurgery 67:1581–1587; discussion 1587-1588. https://doi.org/10.1227/NEU.0b013e3181f74120
Kiya N, Bannur U, Yamauchi 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 143:365–368
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 106:384–387. https://doi.org/10.3171/jns.2007.106.3.384
Moller AR, Jannetta PJ (1986) Physiological abnormalities in hemifacial spasm studied during microvascular decompression operations. Exp Neurol 93:584–600
Montero J, Junyent J, Calopa M, Povedano M, Valls-Sole J (2007) Electrophysiological study of ephaptic axono-axonal responses in hemifacial spasm. Muscle Nerve 35:184–188. https://doi.org/10.1002/mus.20674
Nielsen VK (1984) Pathophysiology of hemifacial spasm: II. Lateral spread of the supraorbital nerve reflex. Neurology 34:427–431. https://doi.org/10.1212/wnl.34.4.427
Sen CN, Moller AR (1987) Signs of hemifacial spasm created by chronic periodic stimulation of the facial nerve in the rat. Exp Neurol 98:336–349
Tambasco N, Simoni S, Sacchini E, Eusebi P, Marsili E, Nigro P, Brahimi E, Paoletti FP, Romoli M, Calabresi P (2019) Validation of the Hemifacial Spasm Grading Scale: a clinical tool for hemifacial spasm. Neurol Sci 40:1887–1892. https://doi.org/10.1007/s10072-019-03921-4
Thirumala PD, Shah AC, Nikonow TN, Habeych ME, Balzer JR, Crammond DJ, Burkhart L, Chang YF, Gardner P, Kassam AB, Horowitz MB (2011) Microvascular decompression for hemifacial spasm: evaluating outcome prognosticators including the value of intraoperative lateral spread response monitoring and clinical characteristics in 293 patients. J Clin Neurophysiol 28:56–66. https://doi.org/10.1097/WNP.0b013e3182051300
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 75:198–203. https://doi.org/10.1055/s-0034-1368145
Wang X, Thirumala PD, Shah A, Gardner P, Habeych M, Crammond D, Balzer J, Burkhart L, Horowitz M (2013) Microvascular decompression for hemifacial spasm: focus on late reoperation. Neurosurg Rev 36:637–643; discussion 643-634. https://doi.org/10.1007/s10143-013-0480-z
Weber GA (1990) Nerve conduction studies and their clinical applications. Clin Podiatr Med Surg 7:151–178
Wilkinson MF, Chowdhury T, Mutch WA, Kaufmann AM (2014) Is hemifacial spasm a phenomenon of the central nervous system? - the role of desflurane on the lateral spread response. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. https://doi.org/10.1016/j.clinph.2014.09.030
Yamashita S, Kawaguchi T, Fukuda M, Suzuki K, Watanabe M, Tanaka R, Kameyama S (2002) Lateral spread response elicited by double stimulation in patients with hemifacial spasm. Muscle Nerve 25:845–849. https://doi.org/10.1002/mus.10123
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (KMC IRB 1511-14) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Park, C.K., Lim, S.H., Lee, S.H. et al. Is the pre-operative lateral spread response on facial electromyography a valid diagnostic tool for hemifacial spasm?. Neurosurg Rev (2021). https://doi.org/10.1007/s10143-020-01267-6
- Hemifacial spasm
- Microvascular decompression
- Lateral spreading response
- Abnormal muscle response
- Facial electromyography