Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Department of Neurosurgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 West Beijing Road, Huaian, 223001, Jiangsu, China.
Acta Neurochir (Wien). 2022 Mar;164(3):827-832. doi: 10.1007/s00701-021-05076-8. Epub 2021 Dec 6.
Microvascular decompression (MVD) has become an accepted treatment modality for the vertebral artery (VA)-involved hemifacial spasm (HFS). The aim of this retrospective study was to evaluate clinical and surgical outcomes of HFS patients undergoing MVD and surgical and cranial nerve complications and investigate reasonable transposition procedures for two different anatomic variations of VA.
Between January and December 2018, 109 patients underwent first MVD for HFS involving VA at Nanjing Drum Tower Hospital. Based on whether the VA could be moved ventrally at the lower cranial nerves (LCNs) level, patients were assigned to Group A (movable VA, n = 72) or B (unmovable VA, n = 37), and clinical and surgical outcomes and complications on the day of post-surgery and during follow-up were assessed. All patients were followed up ranging from 17 to 24 months with a mean follow-up period of 21 months.
After a mean follow-up of 21 months, the total cure rate significantly decreased in all patients compared to that achieved on the day of surgery, and Group A patients exhibited a higher cure rate versus Group B (93.1% vs. 75.7%, P = 0.015). Group B patients with unmovable VA revealed both higher incidence of surgical complications (45.9% vs. 15.3%, P = 0.001) and frequency of bilateral VA compression (27% vs. 8.3%, P = 0.009) versus Group A. No significant difference was observed in long-term cranial nerve complications.
VA-involved HFS can benefit from MVD strategies after preoperative assessment of VA compression. HFS patients with movable VA may receive better long-term efficacy and fewer complications. A Teflon bridge wedged between the distal VA and medulla gives rise to adequate space for decompression surgery.
微血管减压术（MVD）已成为椎动脉（VA）受累面肌痉挛（HFS）的一种公认的治疗方式。本回顾性研究旨在评估在南京鼓楼医院接受 MVD 治疗的 HFS 患者的临床和手术结果，以及手术和颅神经并发症，并探讨两种不同 VA 解剖变异的合理转位手术。
2018 年 1 月至 12 月期间，109 例 VA 受累 HFS 患者在南京鼓楼医院行首次 MVD。根据 VA 在颅神经（LCNs）水平是否可向下移位，将患者分为 A 组（可移动 VA，n=72）或 B 组（不可移动 VA，n=37），评估术后当天和随访期间的临床和手术结果及并发症。所有患者均随访 17-24 个月，平均随访 21 个月。
平均随访 21 个月后，与手术当天相比，所有患者的总治愈率均显著降低，A 组患者的治愈率高于 B 组（93.1% vs. 75.7%，P=0.015）。B 组不可移动 VA 患者的手术并发症发生率（45.9% vs. 15.3%，P=0.001）和双侧 VA 受压发生率（27% vs. 8.3%，P=0.009）均高于 A 组。长期颅神经并发症无显著差异。
术前评估 VA 压迫后，VA 受累 HFS 可受益于 MVD 策略。可移动 VA 的 HFS 患者可能获得更好的长期疗效和更少的并发症。将 Teflon 桥楔入远端 VA 和延髓之间，为减压手术提供足够的空间。
