| Part one:Microvascular Decompression for Hemifacial Spasm Included Vertebral ArteryObjective:To disscuss the surgical techniques,outcomes and complications of microvascular decompression(MVD)for treatment of hemifacial spasm(HFS)with offending vessels includingthe vertebral artery(VA).Methods:A total of 783 patients with HFS undergoing MVD at Deparment of Neurosurgery,China-Japan FriendshipHospital from January 2010 and February 2012 by the same surgeon were retrospectively enrolled into this study.Among them,125 cases(16.0%)were found to have offending vsessels including VA and were classified into VA group.The other 685 cases(84.0%)did not have VA as the offending vessel and belonged to non-VA(NVA)group.The clinical characteristics,surgical techniques,efficacies and complications were analyzed for the two groups.Results:In the VA group,120 cases(96.0%)had offending vessels including VA and other arteries.Out of the 120 cases,VA acted as the only main offending vessel or one of the main offending vessels in 11 cases,and as the secondary offending vessel in 109 cases.VA was identified as the only offending vessel in 5 cases(4.0%).Compared with the NVA group,the symptoms in VA group seemed to affect more commonly the left side and male patients(all P<0.05).The mean follow-up time is 51 months(ranged from 46 to 60 months).In the VA group,the operative delayed curing rate,median delayed curing time and rates of significant ipsilateral hearing loss,immediate postoperative facial paralysis,delayed facial paralysis,injury of posterior group of cranial nerves as well as intracranial bleeding were all higher than those in NVA group,and the differences were statistically significant(all P<0.05).Between the two groups,no difference was identified in the patients age,duration of illness and effective rate of operation(all P>0.05).Conclusions:It seems uncommon that VA acts as the only major offending vessel,which tends to be the secondary offending vessel and results in compression together with other arteris.The efficacy of MVD in HFS involing offending vessels including VA is suggested to be certain.Compared with the NVA patients,delayed curing is more likely to occur with later remission in VA patients.The postoperative complicationsrates of significant ipsilateral hearing loss,immediate postoperative facial paralysis,delayed facial paralysis,injury of posterior group of cranial nerves as well as intracranial bleeding post MVD were more commonly obeseved in VA patients than in NVA patients.Part two:Microvascular Decompression for Treatment of Trigeminal Neuralgia Caused by Non-arterial Compression FactorsObjective:To discuss the surgical methods,techniques,outcomes,and complications of microvascular decompression(MVD)for treatment of trigeminal neuralgia(TN)caused by non-arterial compression factors.Methods:A total of 251 patients withcomplete clinical data of TN undergoing MVD at Department of Neurosurgery,China-Japan FriendshipHospital from May 2006 and December 2016 by the same surgeon were retrospectively enrolled into this study.Among them,36 patients(14.3%)were caused by non-arterial compression(NA group);215 patients(85.7%)were caused by arterial compression(A group).In the NA group,19 cases were caused by single offending vein compression,of which 12 cases were undertaken MVD successfully,7 cases over 60 years of age were undertaken selective partial rhizotomy(PR)after unsatisfied MVD,and the PR range of trigeminal sensory root was 1/3?2/3;17 cases in the NA group of 36 cases were found no offending vessels,of which 12 cases were undertaken radical release of trigeminal nerve root,and the trigeminal nerve root was completely dissected from the brain stem to the Meckel'scave making it completely loosened on the axis,and 5 patientsover 60 years of age were then undertaken PR.In A group of the 215 patients,190 cases were routinely performed MVD,and 25 cases over 60 years of age were undertaken PR after difficult MVD.Results:In the NA group,19 cases(52.8%)had only offending vessels of superior petrosal veins and branches,and 17 cases(47.2%)had no offending vessels.In the A group,the offending vesselscomposed of SCA,AICA,superior petrosal vein branche,and basilar artery(BA).The mean follow-up time is 67 months(range from 14 to 142 months).Inthe NA group,the total effective rate was 88.9%(32/36),the recurrence rate was 5.9%(2/34),and the incidence of postoperativecerebralnerve related complications was 8.3%(3/36);In the A group,the total effective rate of was 85.6%(184/215),the recurrence rate was 4.2%(8/192),and the incidence of postoperativecerebral nerve related complications was 8.4%(18/215).Compared with the A group,there was no significant difference in age,sex,diseased side,course,total effective rate,recurrence rate,and the incidence of cerebral nerve related complications in the NA group(P>0.05).Conclusions:It seems that non-arterial compression factors were not uncommon in the TN MVD.The offending vessels of superior petrosal vein branches should be fully loosened and free after MVD;we should fully release the adhesions around the sensory root of the trigeminal nerve if we found no offending vessels;of which the patients older than 60 years old should be undertaken PR after MVD.According to the above principles,the non arterial compression factors ofTN patients also get good results. |
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