Mizobuchi Yoshifumi, Nagahiro Shinji, Kondo Akinori, Arita Kazunori, Date Isao, Fujii Yukihiko, Fujimaki Takamitsu, Hanaya Ryosuke, Hasegawa Mitsuhiro, Hatayama Toru, Hongo Kazuhiro, Inoue Tooru, Kasuya Hidetoshi, Kobayashi Masahito, Kohmura Eiji, Matsushima Toshio, Masuoka Jun, Morita Akio, Munemoto Shigeru, Nishizawa Shigeru, Okayama Yoshihiro, Sato Kimitoshi, Shigeno Taku, Shimano Hiroshi, Takeshima Hideo, Tanabe Hideki, Yamakami Iwao
Department of Neurosurgery, Tokushima University Faculty of Medicine, Tokushima, Japan.
Brain and Spine Surgery Center, Shiroyama Hospital, Osaka, Japan.
Neurosurgery. 2021 Mar 15;88(4):846-854. doi: 10.1093/neuros/nyaa549.
Microvascular decompression (MVD) is the most effective procedure for hemifacial spasm (HFS). MVD results from nonspecialized or low-volume institutes are not always reliable. Most studies on MVD for HFS are retrospective and single centered; to the best of our knowledge, no prospective, multicenter studies exist.
To evaluate short- and long-term outcomes and complications in patients who underwent MVD for HFS in specialized Japanese institutions, in this multicenter, prospective, cohort study.
Included patients had undergone MVD for HFS in study centers between April 2012 and March 2015. Patients' postoperative grade of involuntary movements and complications were recorded postoperatively at 7 d (short-term) and at 1 (mid-term) and 3 (long-term) yr.
A total of 486 patients (150 men, 336 women; mean age 53.9 yr with 181 patients over 60 yr) were enrolled during the study period. Neuromonitoring was used in 96.3% of the cases. The complete cure rate of symptom relief, mortality rate, and complication rate at short-term follow-up were 70.6%, 0%, and 15%, respectively. The long-term follow-up was completed by 463 patients (95.3%); the complete cure rate of symptom relief and complication rate were 87.1% and 3.0%, respectively.
Our study revealed that under expert guidance and intraoperative neuromonitoring, the long-term curative effect rate of MVD for HFS is high, while complications are uncommon and usually transient. Our results indicate that MVD is an effective and safe treatment for patients with HFS, including elderly patients.
微血管减压术（MVD）是治疗面肌痉挛（HFS）最有效的方法。非专业或小容量机构开展的MVD手术效果并不总是可靠的。大多数关于MVD治疗HFS的研究都是回顾性的且为单中心研究；据我们所知，尚无前瞻性、多中心研究。
在这项多中心、前瞻性队列研究中，评估在日本专业机构接受MVD治疗HFS患者的短期和长期疗效及并发症。
纳入的患者于2012年4月至2015年3月期间在研究中心接受了MVD治疗HFS。术后7天（短期）、1年（中期）和3年（长期）记录患者非自主运动的术后分级和并发症情况。
研究期间共纳入486例患者（男性150例，女性336例；平均年龄53.9岁，其中181例患者年龄超过60岁）。96.3%的病例使用了神经监测。短期随访时症状缓解的完全治愈率、死亡率和并发症发生率分别为70.6%、0%和15%。463例患者（95.3%）完成了长期随访；症状缓解的完全治愈率和并发症发生率分别为87.1%和3.0%。
我们的研究表明，在专家指导和术中神经监测下，MVD治疗HFS的长期治愈率高，而并发症罕见且通常为一过性。我们的结果表明，MVD是治疗HFS患者（包括老年患者）的一种有效且安全的治疗方法。
