• Minsoo Kim, Kyung Rae Cho, Sang-Ku Park, Chiman Jeon, and Kwan Park.
• Department of Neurosurgery, Gangneung Asan Hospital, Gangneung, Republic of Korea.
• Neurosurgery. 2022 Jul 1; 91 (1): 159-166.

BackgroundThe predictive value of intraoperative disappearance of the lateral spread response (LSR) during microvascular decompression surgery for hemifacial spasm treatment is unclear. Studies evaluating the clinical implications of the LSR recorded during the postoperative period are also limited.ObjectiveTo analyze the LSR 1 month postoperatively and to evaluate its prognostic value until 1 year postsurgery.MethodsIn total, 883 patients who underwent microvascular decompression between 2016 and 2018 were included. LSR was recorded preoperatively, intraoperatively before decompression, intraoperatively after decompression, and 1 month postoperatively. The outcomes were evaluated at 1 week, 1 month, and 1 year postoperatively.ResultsThe presence of preoperative and intraoperative LSR after decompression did not predict the postoperative outcome at 1 year. In 246 patients (27.9%), the postoperative LSR at 1 month was not identical to that recorded intraoperatively after decompression. Postoperative LSR at 1 month was associated with a worse outcome at 1 month (P < .0001) and 1 year (P = .0002) postoperatively. Patients with residual symptoms and a LSR 1 month postoperatively were more likely to show residual symptoms 1 year postoperatively, with a positive predictive value of 50.7%.ConclusionUnlike the intraoperative LSR, the LSR at 1 month postoperatively showed prognostic value in predicting 1-year postoperative outcomes and was useful for identifying patients with a high risk of unfavorable outcomes. Thus, confirming the presence of postoperative LSR is necessary.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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