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Intraoperative Neurophysiological Monitoring during Microvascular Decompression Surgery for Hemifacial Spasm

Journal of Korean Neurosurgical Society 2019년 62권 4호 p.367 ~ 375
 ( Park Sang-Ku ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Neurology

 ( Joo Byung-Euk ) - Hanyang University Medical Center Myongji Hospital Department of Neurology
 ( Park Kwan ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Neurosurgery

Abstract


Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.

키워드

Hemifacial spasm; Microvascular decompression surgery; Intraoperative neurophysiological monitoring
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