Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainst...Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainstem. Numerous prospective and retrospective case series have confirmed the efficacy of microvascular decompression(MVD) of the facial nerve in patients with HFS. However, while MVD is effective, there are still significant postoperative complications. In this paper, recent technological advances related to MVD(such as lateral spread response,brainstem auditory evokes potential, three dimensional time of flight magnetic resonance angiography, intraoperative neuroendoscopy) are reviewed for the purposes of improving MVD treatment efficacy and reducing postoperative complications.展开更多
Objective To summarize our clinical experience of microvascular decompression (MVD)for medically intractable hemifacial spasm(HFS) patients with emphasis on microsurgical manipulation and to improve cure rate and avoi...Objective To summarize our clinical experience of microvascular decompression (MVD)for medically intractable hemifacial spasm(HFS) patients with emphasis on microsurgical manipulation and to improve cure rate and avoid surgical complications. Methods Three hundred and thirty-eight patients with HFS underwent MVD under general anesthesia . With the help of 'zero retraction' technique, prosthesis can be properly inserted between offending vessel loop and affected facial nerve REZ in a 'rolling ball' fashion under operative microscope. Results Surgical intervention achieved high relief rate of 91 .4% and no major complications, with low recurrence rate of only 3.2% after averaging more than two years' follow-up ( M = 32 months). Conclusion It is possible to approach to the facial nerve REZ with 'zero retraction', which is fundamentally important to clear from cranial nerve and cerebellar injury. Skilled microsurgical technique along with correct recognition and mobilization of offending vessels are a must to assure MVD a highly efficacious and low risk treatment of choice for HFS patients.展开更多
BACKGROUND Neurovascular compression(NVC) is the main cause of primary trigeminal neuralgia(TN) and hemifacial spasm(HFS). Microvascular decompression(MVD) is an effective surgical method for the treatment of TN and H...BACKGROUND Neurovascular compression(NVC) is the main cause of primary trigeminal neuralgia(TN) and hemifacial spasm(HFS). Microvascular decompression(MVD) is an effective surgical method for the treatment of TN and HFS caused by NVC. The judgement of NVC is a critical step in the preoperative evaluation of MVD, which is related to the effect of MVD treatment. Magnetic resonance imaging(MRI) technology has been used to detect NVC prior to MVD for several years. Among many MRI sequences, three-dimensional time-of-flight magnetic resonance angiography(3D TOF MRA) is the most widely used. However, 3D TOF MRA has some shortcomings in detecting NVC. Therefore, 3D TOF MRA combined with high resolution T2-weighted imaging(HR T2WI) is considered to be a more effective method to detect NVC.AIM To determine the value of 3D TOF MRA combined with HR T2WI in the judgment of NVC, and thus to assess its value in the preoperative evaluation of MVD.METHODS Related studies published from inception to September 2022 based on PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Studies that investigated 3D TOF MRA combined with HR T2WI to judge NVC in patients with TN or HFS were included according to the inclusion criteria. Studies without complete data or not relevant to the research topics were excluded. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to assess the quality of included studies. The publication bias of the included literature was examined by Deeks’ test. An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize data. Data analysis was performed using the MIDAS module of statistical software Stata 16.0. Two independent investigators extracted patient and study characteristics, and discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. The I_(2) statistic and Q test were used to test heterogeneity. The study was registered on the website of PROSERO(registration No. CRD42022357158).RESULTS Our search identified 595 articles, of which 12(including 855 patients) fulfilled the inclusion criteria. Bivariate analysis showed that the pooled sensitivity and specificity of 3D TOF MRA combined with HR T2WI for detecting NVC were 0.96 [95% confidence interval(CI): 0.92-0.98] and 0.92(95%CI: 0.74-0.98), respectively. The pooled positive likelihood ratio was 12.4(95%CI: 3.2-47.8), pooled negative likelihood ratio was 0.04(95%CI: 0.02-0.09), and pooled diagnostic odds ratio was 283(95%CI: 50-1620). The area under the receiver operating characteristic curve was 0.98(95%CI: 0.97-0.99). The studies showed no substantial heterogeneity(I2 = 0, Q = 0.001 P = 0.50).CONCLUSION Our results suggest that 3D TOF MRA combined with HR T2WI has excellent sensitivity and specificity for judging NVC in patients with TN or HFS. This method can be used as an effective tool for preoperative evaluation of MVD.展开更多
BACKGROUND： Microvascular decompression has become a well-accepted, safe method in the treatment of hemifacial spasms. However, postoperative complications exist and influence the prognosis of the disease. OBJECTIVE...BACKGROUND： Microvascular decompression has become a well-accepted, safe method in the treatment of hemifacial spasms. However, postoperative complications exist and influence the prognosis of the disease. OBJECTIVE： This study aimed to analyze, by case review, the characteristics and regularity of microvascular decompression complications in the treatment of hemifacial spasm. DESIGN： Retrospective analysis. SETTING： Beijing General Group Hospital of the Chinese People＇s Armed Police Forces. PARTICIPANTS： A total of 156 patients with hemifacial spasm were admitted to the Department of Neurosurgery, Beijing General Group Hospital of the Chinese People＇s Armed Police Forces from June 2004 to June 2006 and recruited for this study. The patients, 57 males and 99 females, averaged 46 years of age （range 17-68-years old）. All suffered from facial innervated muscular paroxysmal and recurrent contraction, which could not be controlled by consciousness. Electromyogram demonstrated waves of fibrillation and fasciculation. Prior to admission, all patients had received other treatments. Written informed consents for treatment were obtained from all patients. This protocol was approved by the Hospital＇s Ethics Committee. METHODS： After anesthesia, a cranial bone pore was drilled below the connection of the lateral sinus and sigmoid sinus. Dura mater was dissected at the ＂⊥＂ shape and held in the air. Under microscopy, the flocculus cerebelli was lifted slightly up for convenient observation of the cerebellopontine angle. The mucous membrane was sharply separated. Corresponding vessels were identified at the root of the facial nerves and subsequently liberated and disassociated from the root exit zone. Suitably sized Teflon cotton was placed between the corresponding vessels and brain stem. MAIN OUTCOME MEASURES： Complications of microvascular decompression. RESULTS： All 156 patients participated in the final analysis. （1） Postoperatively, 66 （42%） patients presented with obvious headache or dizziness, 5 （3%） with severe headache, 43 （28%） with nausea or vomiting for 12 hours to 3 days, and 19 （12%） with aseptic meningitis and a body temperature of 37.5-40 ℃ Patients, who suffered from headache and fever, were cured after 2-5 lumbar punctures. （2） Postoperatively, 19 （8%） patients suffered from short-term dysaudia and tinnitus on the affected side, 9 （6%） from mild hemifacial spasms, and 2 （1%） from ambiopia. All patients were cured after treatment with a neurotrophic drug. （3） Postoperatively, 4 （2%） patients suffered from cerebrospinal fluid incision leakage and 2 （1%） from cerebrospinal rhinorrhea. The cerebrospinal fluid incision was tightly sutured. One case of cerebrospinal rhinorrhea was cured after mastoid process repair, and the other one recovered spontaneously. CONCLUSION： Experimental results have indicated that low intracranial pressure is the main complication of microvascular decompression in patients with hemifacial spasms, and no permanent neuro-functional impairment was found.展开更多
BACKGROUND Aneurysm compression,diabetes,and traumatic brain injury are well-known causative factors of oculomotor nerve palsy(ONP),while cases of ONP induced by neurovascular conflicts have rarely been reported in th...BACKGROUND Aneurysm compression,diabetes,and traumatic brain injury are well-known causative factors of oculomotor nerve palsy(ONP),while cases of ONP induced by neurovascular conflicts have rarely been reported in the medical community.Here,we report a typical case of ONP caused by right posterior cerebral artery(PCA)compression to increase neurosurgeons’awareness of the disease and reduce misdiagnosis and recurrence.CASE SUMMARY A 54-year-old man without a known medical history presented with right ONP for the past 5 years.The patient presented to the hospital with right ptosis,diplopia,anisocoria(rt 5 mm,lt 2.5 mm),loss of duction in all directions,abduction,and light impaired pupillary reflexes.Magnetic resonance angiography and computed tomography venography examinations showed no phlebangioma,aneurysm,or intracranial lesion.After conducting oral glucose tolerance and prostigmin tests,diabetes and myasthenia gravis were excluded.Cranial nerve magnetic resonance imaging showed that the right PCA loop was in direct contact with the cisternal segment of the right oculomotor nerve(ON).Microvascular decompression(MVD)of the culprit vessel from the ON through a right subtemporal craniotomy was carried out,and the ONP symptoms were significantly relieved after 3 mo.CONCLUSION Vascular compression of the ON is a rare pathogeny of ONP that may be refractory to drug therapy and ophthalmic strabismus surgery.MVD is an effective treatment for ONP induced by neurovascular compression.展开更多
Objective:To explore the value of microvascular decompression in the treatment of trigeminal neuralgia.Methods:The clinical data of 80 patients with trigeminal neuralgia who admitted to our hospital from February 2015...Objective:To explore the value of microvascular decompression in the treatment of trigeminal neuralgia.Methods:The clinical data of 80 patients with trigeminal neuralgia who admitted to our hospital from February 2015 to February 2019 were retrospectively analyzed.The patients were randomly divided into two groups.The control group received routine treatment,and the observation group underwent microvascular decompression.Results:The total effective rate of the observation group was higher than that of the control group,P<0.05.The recurrence rate of the observation group was lower than that of the control group,P<0.05.Conclusion:Microvascular decompression for the treatment of trigeminal neuralgia can significantly improve the efficacy and reduce the recurrence.展开更多
Objective To research the factors that affects the efficacy of 2 826 cases of of trigeminal neuralgia after microvascular decompression during follow-up more than 1 year. Methods The patients with trigeminal meuralgia...Objective To research the factors that affects the efficacy of 2 826 cases of of trigeminal neuralgia after microvascular decompression during follow-up more than 1 year. Methods The patients with trigeminal meuralgia were followed-up for 1-25 years ( mean 9. 8 years) after microvascular decompression from January 1984 to展开更多
文摘Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainstem. Numerous prospective and retrospective case series have confirmed the efficacy of microvascular decompression(MVD) of the facial nerve in patients with HFS. However, while MVD is effective, there are still significant postoperative complications. In this paper, recent technological advances related to MVD(such as lateral spread response,brainstem auditory evokes potential, three dimensional time of flight magnetic resonance angiography, intraoperative neuroendoscopy) are reviewed for the purposes of improving MVD treatment efficacy and reducing postoperative complications.
文摘Objective To summarize our clinical experience of microvascular decompression (MVD)for medically intractable hemifacial spasm(HFS) patients with emphasis on microsurgical manipulation and to improve cure rate and avoid surgical complications. Methods Three hundred and thirty-eight patients with HFS underwent MVD under general anesthesia . With the help of 'zero retraction' technique, prosthesis can be properly inserted between offending vessel loop and affected facial nerve REZ in a 'rolling ball' fashion under operative microscope. Results Surgical intervention achieved high relief rate of 91 .4% and no major complications, with low recurrence rate of only 3.2% after averaging more than two years' follow-up ( M = 32 months). Conclusion It is possible to approach to the facial nerve REZ with 'zero retraction', which is fundamentally important to clear from cranial nerve and cerebellar injury. Skilled microsurgical technique along with correct recognition and mobilization of offending vessels are a must to assure MVD a highly efficacious and low risk treatment of choice for HFS patients.
基金Supported by the Key Research and Development Plan of Shaanxi Province,No.2021SF-298.
文摘BACKGROUND Neurovascular compression(NVC) is the main cause of primary trigeminal neuralgia(TN) and hemifacial spasm(HFS). Microvascular decompression(MVD) is an effective surgical method for the treatment of TN and HFS caused by NVC. The judgement of NVC is a critical step in the preoperative evaluation of MVD, which is related to the effect of MVD treatment. Magnetic resonance imaging(MRI) technology has been used to detect NVC prior to MVD for several years. Among many MRI sequences, three-dimensional time-of-flight magnetic resonance angiography(3D TOF MRA) is the most widely used. However, 3D TOF MRA has some shortcomings in detecting NVC. Therefore, 3D TOF MRA combined with high resolution T2-weighted imaging(HR T2WI) is considered to be a more effective method to detect NVC.AIM To determine the value of 3D TOF MRA combined with HR T2WI in the judgment of NVC, and thus to assess its value in the preoperative evaluation of MVD.METHODS Related studies published from inception to September 2022 based on PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Studies that investigated 3D TOF MRA combined with HR T2WI to judge NVC in patients with TN or HFS were included according to the inclusion criteria. Studies without complete data or not relevant to the research topics were excluded. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to assess the quality of included studies. The publication bias of the included literature was examined by Deeks’ test. An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize data. Data analysis was performed using the MIDAS module of statistical software Stata 16.0. Two independent investigators extracted patient and study characteristics, and discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. The I_(2) statistic and Q test were used to test heterogeneity. The study was registered on the website of PROSERO(registration No. CRD42022357158).RESULTS Our search identified 595 articles, of which 12(including 855 patients) fulfilled the inclusion criteria. Bivariate analysis showed that the pooled sensitivity and specificity of 3D TOF MRA combined with HR T2WI for detecting NVC were 0.96 [95% confidence interval(CI): 0.92-0.98] and 0.92(95%CI: 0.74-0.98), respectively. The pooled positive likelihood ratio was 12.4(95%CI: 3.2-47.8), pooled negative likelihood ratio was 0.04(95%CI: 0.02-0.09), and pooled diagnostic odds ratio was 283(95%CI: 50-1620). The area under the receiver operating characteristic curve was 0.98(95%CI: 0.97-0.99). The studies showed no substantial heterogeneity(I2 = 0, Q = 0.001 P = 0.50).CONCLUSION Our results suggest that 3D TOF MRA combined with HR T2WI has excellent sensitivity and specificity for judging NVC in patients with TN or HFS. This method can be used as an effective tool for preoperative evaluation of MVD.
文摘BACKGROUND： Microvascular decompression has become a well-accepted, safe method in the treatment of hemifacial spasms. However, postoperative complications exist and influence the prognosis of the disease. OBJECTIVE： This study aimed to analyze, by case review, the characteristics and regularity of microvascular decompression complications in the treatment of hemifacial spasm. DESIGN： Retrospective analysis. SETTING： Beijing General Group Hospital of the Chinese People＇s Armed Police Forces. PARTICIPANTS： A total of 156 patients with hemifacial spasm were admitted to the Department of Neurosurgery, Beijing General Group Hospital of the Chinese People＇s Armed Police Forces from June 2004 to June 2006 and recruited for this study. The patients, 57 males and 99 females, averaged 46 years of age （range 17-68-years old）. All suffered from facial innervated muscular paroxysmal and recurrent contraction, which could not be controlled by consciousness. Electromyogram demonstrated waves of fibrillation and fasciculation. Prior to admission, all patients had received other treatments. Written informed consents for treatment were obtained from all patients. This protocol was approved by the Hospital＇s Ethics Committee. METHODS： After anesthesia, a cranial bone pore was drilled below the connection of the lateral sinus and sigmoid sinus. Dura mater was dissected at the ＂⊥＂ shape and held in the air. Under microscopy, the flocculus cerebelli was lifted slightly up for convenient observation of the cerebellopontine angle. The mucous membrane was sharply separated. Corresponding vessels were identified at the root of the facial nerves and subsequently liberated and disassociated from the root exit zone. Suitably sized Teflon cotton was placed between the corresponding vessels and brain stem. MAIN OUTCOME MEASURES： Complications of microvascular decompression. RESULTS： All 156 patients participated in the final analysis. （1） Postoperatively, 66 （42%） patients presented with obvious headache or dizziness, 5 （3%） with severe headache, 43 （28%） with nausea or vomiting for 12 hours to 3 days, and 19 （12%） with aseptic meningitis and a body temperature of 37.5-40 ℃ Patients, who suffered from headache and fever, were cured after 2-5 lumbar punctures. （2） Postoperatively, 19 （8%） patients suffered from short-term dysaudia and tinnitus on the affected side, 9 （6%） from mild hemifacial spasms, and 2 （1%） from ambiopia. All patients were cured after treatment with a neurotrophic drug. （3） Postoperatively, 4 （2%） patients suffered from cerebrospinal fluid incision leakage and 2 （1%） from cerebrospinal rhinorrhea. The cerebrospinal fluid incision was tightly sutured. One case of cerebrospinal rhinorrhea was cured after mastoid process repair, and the other one recovered spontaneously. CONCLUSION： Experimental results have indicated that low intracranial pressure is the main complication of microvascular decompression in patients with hemifacial spasms, and no permanent neuro-functional impairment was found.
基金Supported by National Natural Science Foundation of China,No.32070791the Key Scientific Research Projects of Military Logistics,No.BWJ20J002.
文摘BACKGROUND Aneurysm compression,diabetes,and traumatic brain injury are well-known causative factors of oculomotor nerve palsy(ONP),while cases of ONP induced by neurovascular conflicts have rarely been reported in the medical community.Here,we report a typical case of ONP caused by right posterior cerebral artery(PCA)compression to increase neurosurgeons’awareness of the disease and reduce misdiagnosis and recurrence.CASE SUMMARY A 54-year-old man without a known medical history presented with right ONP for the past 5 years.The patient presented to the hospital with right ptosis,diplopia,anisocoria(rt 5 mm,lt 2.5 mm),loss of duction in all directions,abduction,and light impaired pupillary reflexes.Magnetic resonance angiography and computed tomography venography examinations showed no phlebangioma,aneurysm,or intracranial lesion.After conducting oral glucose tolerance and prostigmin tests,diabetes and myasthenia gravis were excluded.Cranial nerve magnetic resonance imaging showed that the right PCA loop was in direct contact with the cisternal segment of the right oculomotor nerve(ON).Microvascular decompression(MVD)of the culprit vessel from the ON through a right subtemporal craniotomy was carried out,and the ONP symptoms were significantly relieved after 3 mo.CONCLUSION Vascular compression of the ON is a rare pathogeny of ONP that may be refractory to drug therapy and ophthalmic strabismus surgery.MVD is an effective treatment for ONP induced by neurovascular compression.
文摘Objective:To explore the value of microvascular decompression in the treatment of trigeminal neuralgia.Methods:The clinical data of 80 patients with trigeminal neuralgia who admitted to our hospital from February 2015 to February 2019 were retrospectively analyzed.The patients were randomly divided into two groups.The control group received routine treatment,and the observation group underwent microvascular decompression.Results:The total effective rate of the observation group was higher than that of the control group,P<0.05.The recurrence rate of the observation group was lower than that of the control group,P<0.05.Conclusion:Microvascular decompression for the treatment of trigeminal neuralgia can significantly improve the efficacy and reduce the recurrence.
文摘Objective To research the factors that affects the efficacy of 2 826 cases of of trigeminal neuralgia after microvascular decompression during follow-up more than 1 year. Methods The patients with trigeminal meuralgia were followed-up for 1-25 years ( mean 9. 8 years) after microvascular decompression from January 1984 to
