Relationship Between Therapeutic Effect Of Microvascular Decompression For Hemifacial Spasm And The Ways Of Offending Vessel Compresses The Facial Nerve And Neuroelectrophysiological Monitoring

Purpose: Hemifacial spasm(HFS)is a chronic disease characterized by involuntary,paroxysmal,painless convulsions of the muscle group that is dominated by one side of the facial nerve.This disease is born on one side,bilateral is extremely rare.At present,the pathogenesis of HFS is not clear,but it is generally believed that HFS is caused by the pulsation of blood vessels,so the facial nerve microvascular decompression(MVD)is also one of the treatment options.However,since the origin and compression method of blood vessels are diverse,the prognosis of patients is not the same.To this end,we explore the difference of prognosis and complications between offending vascular compression method that was through the clearance between facial nerve and auditory nerve and compressed facial nerve and other ways after microvascular decompression treatment forhemifacial spasm.The effect of electrophysiological monitoring on the postoperative efficacy and complications of MVD was also analyzed.Method: During December 2015 to November 2017,we retrospectively analyzed clinical data of 102 patients who accepted the microvascular decompression for the treatment of Hemifacial spasm at the department of neurosurgery in the First Affiliated Hospital of China Medical University and conducted statistical analysis.According to vascular compression methods are divided into: special group(offending vascular compression method was through the clearance between facial nerve and auditory nerve and compressed facial nerve)has 31 cases;control group(offending vascular compression methods were not through the clearance between facial nerve and auditory nerve)has 71 cases.According to Whether to apply electrophysiological monitoring technology are divided into 37 cases of electrophysiological monitoring group and 65 non-electrophysiological monitoring groups.The postoperative efficacy and complications of groups were compared.Results: In the special group,there were 4 cases of Cohen grade 2,18 cases of grade 3 and 9 cases of grade 4.In the control group,there were 9 cases of Cohen grade 2 grade,42 cases of grade 3 and 20 cases of grade 4.After treatment of MVD,in the special group,there were 20 cases that the postoperative efficacy were cure,4 cases were fine,5 cases were effective,2 cases were invalid(including 1 case of recurrence after 1 year of cure), so 24 patients had good postoperative efficacy and 7 cases were poor postoperative efficacy.In the control group,46 cases were cured,21 cases were fine,2 cases were effective,and 2 case was invalid,so 67 cases were good postoperative efficacy,and 4 cases were poorpostoperative efficacy.There were 9 cases of complications in the special group after MVD surgery,including 4 cases of facioplegia(including 1 case of delayed facial paralysis)?1 case of tinnitus?3 case of facioplegia plus hearing loss?1 case of intracranial infection.Seven patients had complications in the special group after MVD surgery,including 1 cases of facioplegia?1 case of tinnitus ?2 case of hearing loss?1 case of cerebrospinal fluid leakage?1 case of stubborn vertigo?1 case of intracranial infection.In electrophysiological monitoring group,there were 34 cases that the postoperative efficacy were good,3 cases were poor,1 case of facioplegia,36 cases of no obvious complications.In non-electrophysiological monitoring groups,here were 57 cases that the postoperative efficacy were good,8 cases were poor,15 cases of complications and 50 cases of no obvious complications.Conclusions: Compared to other ways of offending vascular compression facial nerve,the way of offending vascular compression methods that was through the clearance between facial nerve and auditory nerve and compressed facial nerve had poorer postoperative efficacy and more complications on the patients who accepted the microvascular decompression for the treatment of primary or idiopathic hemifacial spasm.However,there were no relationships between offending vascular compression methods and preoperative symptom severity ? sex ratio ? disease side and age of onset.Electrophysiological monitoring will help to reduce the incidence of postoperative complications of MVD,no obvious statistical significance for postoperative effect,that are different from other literatures.The reasons may be related to many aspects,such as sample size.