Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, People's Republic of China.
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, People's Republic of China.
Acta Neurochir (Wien). 2020 Nov;162(11):2801-2809. doi: 10.1007/s00701-020-04547-8. Epub 2020 Sep 15.
Numerous factors have been investigated on affecting the outcomes of primary hemifacial spasm (HFS) after microvascular decompression (MVD). It is well established that anatomical differences of the posterior cranial fossa (PCF) plays an important role in the occurrence of HFS. However, it is still not clear whether morphological characteristics of PCF affect the surgical outcomes of HFS after MVD. Our study aims to investigate the prognostic factors for surgical outcomes of MVD for primary HFS, with a particular focus on the morphological characteristics of PCF.
Between January 2014 and November 2017, a total of 152 HFS patients who underwent MVD treatment in our department were included in this study. The clinical data were retrospectively reviewed. The outcomes of MVD were classified into success and failure groups according to the short- and long-term postoperative responses. Particularly, we established an ellipsoid model for PCF. The related length (Y), width (X) and height (Z) of the PCF were measured and the volume of PCF was calculated employing a formula of [Formula: see text]XYZ. The relationship between PCF volume and surgical outcomes was statistically analysed.
The severity of neurovascular compression (NVC) (p = 0.010), type of NVC (p = 0.001) and lateral spread response (LSR) (p < 0.0001) significantly influenced the long-term surgical outcomes of MVD for primary HFS. In particular, for the first time, we demonstrated that a flat-shaped PCF was associated with poor long-term outcome and postoperative recurrence.
Our current study suggests that mild NVC, small vessel compression, intraoperative LSR persistence and flat-shaped PCF are independent factors predicting poor prognosis of MVD for primary HFS.
许多因素已被研究影响微血管减压术（MVD）后原发性面肌痉挛（HFS）的结局。颅后窝（PCF）的解剖差异在 HFS 的发生中起着重要作用，这一点已得到充分证实。然而，PCF 的形态特征是否影响 MVD 后 HFS 的手术结果仍不清楚。我们的研究旨在探讨 MVD 治疗原发性 HFS 的手术结果的预测因素，特别关注 PCF 的形态特征。
2014 年 1 月至 2017 年 11 月，我科共收治 152 例 HFS 患者行 MVD 治疗，回顾性分析其临床资料。根据术后短期和长期反应，将 MVD 结果分为成功组和失败组。特别地，我们建立了 PCF 的椭圆形模型。测量 PCF 的相关长度（Y）、宽度（X）和高度（Z），并采用公式[公式：见文本]XYZ 计算 PCF 的体积。统计分析 PCF 体积与手术结果的关系。
神经血管压迫（NVC）的严重程度（p=0.010）、NVC 类型（p=0.001）和外侧扩散反应（LSR）（p<0.0001）显著影响 MVD 治疗原发性 HFS 的长期手术结果。特别是，我们首次证明扁平形 PCF 与长期预后不良和术后复发有关。
我们的研究表明，轻度 NVC、小血管压迫、术中 LSR 持续存在和扁平形 PCF 是预测 MVD 治疗原发性 HFS 预后不良的独立因素。
