Observation on the clinical effect of different compression types of responsible blood vessels in facial nerve microvascular decompression

doi:10.3877/cma.j.issn.2095-123X.2020.05.002

Abstract

Abstract:

Objective

To explore the clinical significance of continuous multi-modal electrophysiological monitoring of the different degrees of compression of the facial roots entry/exit zone (REZ) of brainstem by the responsible blood vessels in the facial nerve microvascular decompression (MVD) operation.

Methods

The clinical data of 648 patients with hemifacial spasm underwent facial nerve MVD through retrosigmoid sinus approach from March 2017 to March 2019 in Functional Neurosurgery Department of Honghui Hospital Affiliated to Xi’an Jiaotong University were analyzed retrospectively. Lateral spread response (LSR) and brainstem auditory evoked potentials (BAEP) were monitored during the operation. According to the degree of facial nerve root compression observed during the operation, the types of compression are divided into contact compression (blood vessels are only in contact with the REZ microscope), pressure compression (blood vessels form pressure marks in REZ), combined compression of perforator blood vessels (blood vessel branches passing between the facial and auditory nerves), compression of the vertebral artery complex; the number of cases was counted. The relationship between the degree of intraoperative compression and the disappearance of LSR and the change of intraoperative BAEP were observed.

Results

LSR can be monitored before and during the operation. During the operation, 635 cases of LSR disappeared and 13 cases persisted. Among them, 199 cases disappeared after the blood vessel was separated, and 436 cases disappeared after the blood vessel was removed. LSR persisted in 13 cases. A total of 79 cases of BAEP alarm occurred during the operation, including 41 cases of hearing impairment after the operation.

Conclusion

Multimodal electrophysiological monitoring can help the surgeon better judge the responsible blood vessel. Different types of pressure on the facial nerve root by blood vessels are closely related to whether LSR disappears after decompression. The timing of LSR disappearance affects the prognosis and increases the probability of BAEP alarm.

Key words: Hemifacial spasm, Microvascular decompression, Types of compression, Lateral spread response

Jungang Xue, Wenyuan Wei, Dongsheng Zhao, Guohua Deng, Ying Dang, Bifeng Ren, Xiaohua Bie. Observation on the clinical effect of different compression types of responsible blood vessels in facial nerve microvascular decompression[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2020, 10(05): 262-266.

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Figures/Tables 5

References 23

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病例特征		LSR消失（n=635）	LSR持续存在（n=13）	χ²值	P值
性别				0.164	0.685
	男	280	5
	女	355	8
患病侧				0.001	0.920
	左	333	7
	右	302	6
压迫模式				17.240	0.001
	接触压迫	186	1
	压迹压迫	293	3
	穿支压迫	90	7
	椎动脉复合体	66	2
术后1年预后				61.500	0.001
	症状存在	2	6
	症状消失	633	7

病例特征		LSR消失（n=635）	LSR持续存在（n=13）	χ²值	P值
性别				0.164	0.685
	男	280	5
	女	355	8
患病侧				0.001	0.920
	左	333	7
	右	302	6
压迫模式				17.240	0.001
	接触压迫	186	1
	压迹压迫	293	3
	穿支压迫	90	7
	椎动脉复合体	66	2
术后1年预后				61.500	0.001
	症状存在	2	6
	症状消失	633	7

模式	垫离血管前（n=199）	垫离血管后（n=436）
接触压迫	85	101
压迹压迫	84^a	209^a
穿支压迫	13^ab	77^ab
椎动脉复合体	17^ab	49^ab
χ²值	31.689
P值	0.000

模式	垫离血管前（n=199）	垫离血管后（n=436）
接触压迫	85	101
压迹压迫	84^a	209^a
穿支压迫	13^ab	77^ab
椎动脉复合体	17^ab	49^ab
χ²值	31.689
P值	0.000

LSR消失与否	治愈（n=640）	未愈（n=8）
消失	633	2
未消失	7	6
χ²值	0.000
P值	0.000

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