A Clinical Study Of Microvascular Decompression With Keyhole For Cranial Neurovascular Compression Syndrome

Objective By analysis the cranial neurovascular compression syndrome (NVCS) patient’s clinical data and intraoperative findings and neuroimaging seen, to study the impact of prognostic factors for NVCS who treated with keyhole microvascular decompression, for improving surgical outcome and reducing complications.Methods A total of88cases of NVCS patients who have did microvascular decompression (MVD) clinical date were collected during the period of March2011to February2013at Department of Neurosurgery, the Second Hospital of Lanzhou University. To recorded the compressing vessels and compression type, evaluation of surgical treatment/complications and patient satisfaction, Analysis the factors which affect the efficacy of surgery.Results The group of88cases, including trigeminal neuralgia (TN)66cases,18cases of hemifacial spasm (HFS) and glossopharyngeal neuralgia (GPN)4cases. The intraoperative findings no compressing vessel in4cases(4.55%), have the compressing vessel in84cases (95.45%), the types of the vessels, the75cases (85.23%) conspicuous compression, the3cases (4.55%) contact, the6cases (6.82%throughout the nerve root. TN62cases, the neurovascular compression (NVC) vessel:the superior cerebellar artery (SCA)36cases (54.55%), the petrosal vein (PV)21cases (31.82%), the anterior inferior cerebellar artery (AICA)17cases (25.76%); HFS18cases, the NVC vessel:AICA13cases (72.22%) and SCA in3patients (16.67%), posterior inferior cerebellar artery (PICA) in3patients (16.67%); GPN4cases, the NVC vessel:PICA (50%) in2cases,one vertebral artery (VA)(25%), one case was SCA (25%). Follow-up time is1-23months, an average of10.72months. The postoperative effects:TN, the first grade in58cases (87.88%),the second grade in4cases (6.06%), delayed remission in4cases (6.06%), recurrence in4cases (6.06%); HFS,the zero grade in17cases (94.44%), the second grade in1cases (5.56%), delayed remission in2cases,1case of recurrence; GPN, all4cases were cured, no recurrence. Serious complications:Cerebral hemorrhage in3cases (4.55%), including one patient died (1.14%), the other two cases surgery to remove the hematoma. Intracranial infection in2cases (2.27%), cerebrospinal fluid leakage in3cases (3.41%), all were cured. Legacy complications:the second order facial numbness in4cases (4.55%), the second order hearing loss in2cases (2.27%), mild dizziness in3cases (3.41%),2cases (2.27%) with mild facial paralysis, one mild tinnitus patient (1.14%). Comparison of complications in the two-year period, the first year of patients (9cases) significantly more than the second year of patients (2cases)(%2=8.161, P-0.004).The type la TN vascular compression compared with the type lb TN clearer and better efficacy, satisfaction of the two groups of patients for surgery are different (X2=8.360, P=0.013). The Preoperative images find NVC group compared to not find NVC group intraoperative findings and surgical treatment were similar, patient satisfaction were no differences (X2=0.731,P=0.694).Conclusion The NVCS incidence of major Related to the NVC, MVD curative effect is excellent, complications in the acceptable range. For type la TN, the usual NVC clearer and the curative effect better. Surgical curative effect and complications related with the surgeon operating proficiency. Preoperative imaging is not means to determine whether there have NVC vessels and the surgical curative effect.