Relationship Between Therapeutic Effect Of Microvascular Decompression For Hemifacial Spasm And Type Of Offending Vessels

Objectives: To analyze the relationships between type of offending vessel in hemifacial spasm and therapeutic effect of microvascular decompression(MVD).Methord: A retrospective analysis of March 2014-2015 December year in admitted to the Department of Neurosurgery,the second hospital of Hebei Medical University,received 80 cases with hemifacial spasm undergoing MVD.after admission,underwent brain MRI scan and 3D-TOF-MRA imaging and 3D-FIESTA sequence inspection,except for secondary causes,underwent microvascular decompression,were exposed facial nerve brainstem areas,according to the imaging data and surgical findings,explore the offending vessels,according to their different types are divided into two groups: vertebra-basilar artery compression group(offending vessels including the vertebra-basilar artery)in 17 cases;small vascular compression group(offending vessels without vertebra-basilar artery)in 63 cases.To loosen the offending vessels of the facial nerve,insert the right amount of Teflon shim between the blood vessels and the brain stem,observe and track the curative effect and complications of the patients.Results: The observation and follow-up of 12-30 months,46 cases were cured(57.50%),improved in 25 cases(31.25%),invalid in 9 cases(11.25%),effective(cure and improvement)in 71 cases,the total efficiency of 88.75%,vertebra-basilar artery compression group effective 12 cases(70.60%),small vascular compression group 59(93.70% cases),The difference of curative effect between the two groups was statistically significant(P=0.008).Delayed cure in 23 cases(28.75%),vertebra-basilar artery compression group in 8cases(47.06%),small vascular compression group in 15 cases(23.81%),Therate of delayed cure in the vertebra-basilar artery compression group was higher than that in the small vessel compression group,two group delay cure incidence was not statistically significant(P=0.060).Recurrence occurred in 3cases(3.75%),of which there were vertebra-basilar artery compression group(n=1)and small vessel compression group(n=2).The main complications were hearing loss in 8 cases,delayed facial paralysis in 4 cases.Logistic regression analysis: variable type of offending vessels,P value was 0.027,OR value was 5.867,95%CI:1.228-28.018.The offending vessels,including the vertebra-basilar artery,are independent risk factors for poor surgical outcomes.Conclusion: Microvascular decompression is effective in the treatment of primary hemifacial spasm,and the rate of recurrence,inefficacy and complication is low.Hemifacial spasm patient whose offending vessels include the vertebra-basilar artery have worse prognosis.