Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Haidian District, Beijing, 100038, China.
Department of Neurosurgery, Peking University Ninth School of Clinical Medicine, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 10038, China.
BMC Surg. 2023 Oct 27;23(1):331. doi: 10.1186/s12893-023-02214-0.
Microvascular decompression (MVD) is already the preferred surgical treatment for medically refractory neurovascular compression syndromes (NVC) such as hemifacial spasm (HFS), trigeminal neuralgia (TN), and glossopharyngeal neuralgia (GPN). Endoscopy has significantly advanced surgery and provides enhanced visualization of MVD. The aim of this study is to analyze the efficacy and safety of fully endoscopic microvascular decompression (E-MVD) for the treatment of HFS, TN, and GPN, as well as to present our initial experience.
This retrospective case series investigated fully E-MVD performed in 248 patients (123 patients with HFS, 115 patients with TN, and 10 patients with GPN ) from December 2008 to October 2021 at a single institution. The operation duration, clinical outcomes, responsible vessels, intra- and postoperative complications, and recurrences were recorded. Preoperative and immediate postoperative magnetic resonance imaging (MRI) and computerized tomography (CT) were performed for imageological evaluation. The Shorr grading and Barrow Neurological Institute (BNI) pain score were used to evaluate clinical outcomes. The efficacy, safety, and risk factors related to the recurrence of the operation were retrospectively analysed, and the surgical techniques of fully E-MVD were summarised.
A total of 248 patients (103 males) met the inclusion criteria and underwent fully E-MVD were retrospectively studied. The effective rate of 123 patients with HFS was 99.1%, of which 113 cases were completely relieved and 9 cases were significantly relieved. The effective rate of 115 patients with TN was 98.9%, of which 105 cases had completely pain relieved after surgery, 5 cases had significant pain relieved, 4 cases had partial pain relieved but still needed to be controlled by medication. The effective rate of 10 patients with GPN was 100%, 10 cases of GPN were completely relieved after surgery. As for complications, temporary facial numbness occurred in 4 cases, temporary hearing loss in 5 cases, dizziness with frequent nausea and vomiting in 8 cases, headache in 12 cases, and no cerebral hemorrhage, intracranial infection, and other complications occurred. Follow-up ranged from 3 to 42 months, with a mean of 18.6 ± 3.3 months. There were 4 cases of recurrence of HFS and 11 cases of recurrence of TN. The other effective patients had no recurrence or worsening of postoperative symptoms. The cerebellopontine angle (CPA) area ratio (healthy/affected side), the length of disease duration, and the type of responsible vessels are the risk factors related to the recurrence of HFS, TN, and GPN treated by fully E-MVD.
In this retrospective study, our results suggest that the fully E-MVD for the treatment of NVC such as HFS, TN, and GPN, is a safe and effective surgical method. Fully E-MVD for the treatment of NVC has advantages and techniques not available with microscopic MVD, which may reduce the incidence of surgical complications while improving the curative effect and reducing the recurrence rate.
微血管减压术（MVD）已成为治疗药物难治性神经血管压迫综合征（NVC）的首选手术方法，如面肌痉挛（HFS）、三叉神经痛（TN）和舌咽神经痛（GPN）。内窥镜技术显著提高了手术水平，增强了 MVD 的可视化效果。本研究旨在分析全内镜下微血管减压术（E-MVD）治疗 HFS、TN 和 GPN 的疗效和安全性，并介绍我们的初步经验。
本回顾性病例系列研究纳入了 2008 年 12 月至 2021 年 10 月在单中心接受全内镜下 MVD 治疗的 248 例患者（123 例 HFS，115 例 TN，10 例 GPN）。记录手术时间、临床结果、责任血管、围手术期并发症和复发情况。术前和术后即刻行磁共振成像（MRI）和计算机断层扫描（CT）进行影像学评估。采用 Shorr 分级和巴罗神经研究所（BNI）疼痛评分评估临床结果。回顾性分析手术疗效、安全性及与复发相关的危险因素，并总结全内镜下 MVD 的手术技术。
共纳入 248 例（103 例男性）符合纳入标准的患者，并对其行全内镜下 MVD 治疗，进行回顾性研究。123 例 HFS 患者的有效率为 99.1%，其中完全缓解 113 例，显著缓解 9 例。115 例 TN 患者的有效率为 98.9%，其中术后完全缓解 105 例，显著缓解 5 例，部分缓解但仍需药物控制 4 例。10 例 GPN 患者的有效率为 100%，术后 10 例 GPN 完全缓解。并发症方面，暂时性面瘫 4 例，暂时性听力损失 5 例，头晕伴频繁恶心呕吐 8 例，头痛 12 例，无脑出血、颅内感染等并发症。随访时间 3 至 42 个月，平均 18.6±3.3 个月。HFS 复发 4 例，TN 复发 11 例。其余有效患者术后症状无复发或加重。小脑脑桥角（CPA）面积比（健康/患侧）、疾病持续时间和责任血管类型是影响全内镜下 MVD 治疗 HFS、TN 和 GPN 复发的危险因素。
本回顾性研究结果表明，全内镜下 MVD 治疗 HFS、TN 和 GPN 是一种安全有效的手术方法。全内镜下 MVD 治疗 NVC 具有显微镜下 MVD 所不具备的优势和技术，可能在提高疗效的同时降低手术并发症发生率，降低复发率。
