• Marshall F Wilkinson, Tumul Chowdhury, W Alan C Mutch, and Anthony M Kaufmann.
• Section of Neurosurgery, Faculty of Medicine, University of Manitoba and Health Sciences Centre, Winnipeg, MB, Canada.
• Clin Neurophysiol. 2015 Jul 1;126(7):1354-9.

ObjectiveA signature EMG feature of hemifacial spasm (HFS) is the lateral spread response (LSR). Desflurane is a common anesthetic with potent effects on synaptic transmission. We tested the hypothesis that the LSR is mediated by corticobulbar components by comparing the LSR during total intravenous anesthesia (TIVA) or TIVA plus desflurane during microvascular decompression (MVD) surgery.Methods22 HFS patients undergoing MVD surgery participated in this prospective study. The LSR data was recorded from the o. oculi, o. oris and mentalis muscles prior to opening dura. LSR onset latencies and amplitudes were determined under TIVA and TIVA/desflurane (0.5 and 1MAC). Facial muscle LSRs and EEG were analyzed.ResultsDesflurane (1MAC) significantly decreased the LSR amplitude in all 3 facial muscles (p<0.01). Pooled LSR data from all facial muscles showed desflurane inhibited the LSR amplitude by 43% compared to TIVA (p<0.001). No effects on the latency of the LSR or on EEG state were observed.ConclusionsLSR inhibition by desflurane suggests a central mechanism involvement in the genesis of this signature HFS response.SignificanceThis study demonstrates that facial nerve vascular compression and plastic changes within the CNS are part of the pathophysiology of HFS.Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

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