• Xin Zhang, Hua Zhao, Ting-Ting Ying, Yin-Da Tang, Jin Zhu, and Shi-Ting Li.
• Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China.
• World Neurosurg. 2017 May 1; 101: 93-98.

BackgroundMicrovascular decompression (MVD) is the most useful treatment for hemifacial spasm (HFS). During MVD surgery, traditional abnormal muscle response (tAMR) is widely used to monitor success in decompressing the facial nerve. Dual AMR (dAMR) is a new monitoring method used during MVD for HFS. We compared the sensitivities and reliabilities of tAMR and dAMR.MethodsWe performed a retrospective study of 1301 cases of HFS treated using MVD between January 2014 and March 2016. Among the 1301 cases, 587 patients underwent tAMR monitoring and 714 underwent dAMR monitoring.ResultsTypical abnormal muscle response (AMR) waveforms were observed in 484 patients (82.5%) in the tAMR group and in 688 patients (96.4%) in the dAMR group (P < 0.05). AMR waveforms disappeared in 459 patients in the tAMR group and in 655 patients in the dAMR group during MVD. One day, 7 days, 1 month, and 3 months after MVD surgeries with AMR disappearance, the effective rate of MVD was 95.0%, 94.3%, 94.5%, and 95.0%, respectively, in the tAMR group. The corresponding rates were 97.7%, 96.9%, 97.3%, and 98.0% in the dAMR group (P < 0.05). One day, 7 days, 1 month, and 3 months after MVD surgeries with AMR persistence, the effective rate of MVD was 68.0%, 64.0%, 64.0%, and 64.0%, respectively, in the tAMR group. The corresponding rates were 90.9%, 87.9%, 87.9%, and 90.9% in the dAMR group (P < 0.05).ConclusionsAMR monitoring provides valuable neurosurgical guidance during MVD for HFS. dAMR monitoring has better sensitivity and reliability than tAMR monitoring.Copyright © 2017 Elsevier Inc. All rights reserved.

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