Clinical significance of cranial CTA in safety assessment before microvascular decompression

doi:10.3877/cma.j.issn.2095-123X.2021.05.006

Abstract

Abstract:

Objective

To explore the guiding significance of cranial CT angiography (CTA) in preoperative safety assessment of microvascular decompression (MVD) patients.

Methods

The clinical data of patients with primary hemifacial spasm and trigeminal neuralgia treated in the Neurosurgery Department of Nanjing Drum Tower Hospital from January 2018 to June 2019 were analyzed retrospectively. All patients were examined by head CTA before operation. Patients aged over 60 years old or with underlying diseases (such as hypertension, hyperlipidemia, diabetes) were A group. The remaining patients were B group. The detection rate of intracranial aneurysms in group A and B was analyzed. Group A was divided into two subgroups according to the treatment method. The patients with intracranial aneurysms who underwent MVD after intravascular treatment were the observation group, and the other patients who underwent MVD for the first time were the control group. The curative effects and complications of the two groups were observed.

Results

In group A, there were 347 cases, of which 23 cases (6.63%) were found aneurysms. In group B, aneurysms were detected in 3 (1.57%) of 191 cases, and the detection rate of aneurysms in group A was significantly higher than that in group B (P<0.05). The postoperative cure rate and recovery rate of the observation group were 89.47% and 10.53%, respectively. The cure rate and recovery rate of the control group were 93.43% and 5.11%. The total incidence of postoperative complications in the observation group and the control group was 10.53% and 9.48%, without significant difference (P>0.05).

Conclusion

Cranial CTA examination before MVD can effectively detect potential vascular hazards in MVD patients. Especially for elderly patients or patients with underlying diseases, exclusion of surgical contraindications and guidance for surgical treatment are of great guiding significance for the safety evaluation of MVD surgery. Moreover, the efficacy and safety of MVD surgery after intervention for vascular lesions of aneurysms are still reliable.

Key words: Microvascular decompression, Cranial CT angiography, Hemifacial spasm, Trigeminal neuralgia, Preoperative evaluation

Yulong Chong, Wu Xu, Jing Wang, Chengrong Jiang, Weibang Liang. Clinical significance of cranial CTA in safety assessment before microvascular decompression[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(05): 282-284.

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Figures/Tables 2

References 16

[1]	Lv MY, Deng SL, Long XF, et al. Long-term outcome of microvascular decompression for hemifacial spasm[J]. Br J Neurosurg, 2017, 31(3): 322-326.
[2]	Xia L, Zhong J, Zhu J, et al. Effectiveness and safety of microvascular decompression surgery for treatment of trigeminal neuralgia: a systematic review[J]. J Craniofac Surg, 2014, 25(4): 1413-1417.
[3]	Lee MH, Jee TK, Lee JA, et al. Postoperative complications of microvascular decompression for hemifacial spasm: lessons from experience of 2040 cases[J]. Neurosurg Rev, 2016, 39(1): 151-158; discussion 158.
[4]	Mori K, Wada K, Otani N, et al. Validation of effectiveness of keyhole clipping in nonfrail elderly patients with unruptured intracranial aneurysms[J]. J Neurosurg, 2017, 127(6): 1307-1314.
[5]	Wilkinson HA. Hypertension, age, and location predict rupture of small intracranial aneurysms[J]. Neurosurgery, 2007, 61(6): E1340.
[6]	Wu X, Matouk CC, Mangla R, et al. Cost-effectiveness of computed tomography angiography in management of tiny unruptured intracranial aneurysms in the United States[J]. Stroke, 2019, 50(9): 2396-2403.
[7]	Karp BI, Alter K. Botulinum toxin treatment of blepharospasm, orofacial/oromandibular dystonia, and hemifacial spasm[J]. Semin Neurol, 2016, 36(1): 84-91.
[8]	De Toledo IP, Conti Réus J, Fernandes M, et al. Prevalence of trigeminal neuralgia: a systematic review[J]. J Am Dent Assoc, 2016, 147(7): 570-576.e2.
[9]	Ajiboye N, Chalouhi N, Starke RM, et al. Unruptured cerebral aneurysms: evaluation and management[J]. ScientificWorldJournal, 2015, 2015: 954954.
[10]	Andrade L, Hoskoppal A, Hunt Martin M, et al. Intracranial aneurysm and coarctation of the aorta: prevalence in the current era[J]. Cardiol Young, 2021, 31(2): 229-232.
[11]	Kleinloog R, de Mul N, Verweij BH, et al. Risk factors for intracranial aneurysm rupture: a systematic review[J]. Neurosurgery, 2018, 82(4): 431-440.
[12]	Frank H, Heusser K, Geiger H, et al. Temporary reduction of blood pressure and sympathetic nerve activity in hypertensive patients after microvascular decompression[J]. Stroke, 2009, 40(1): 47-51.
[13]	Sasaki S, Tanda S, Hatta T, et al. Neurovascular decompression of the rostral ventrolateral medulla decreases blood pressure and sympathetic nerve activity in patients with refractory hypertension[J]. J Clin Hypertens (Greenwich), 2011, 13(11): 818-820.
[14]	Pyysalo L, Luostarinen T, Keski-Nisula L, et al. Long-term excess mortality of patients with treated and untreated unruptured intracranial aneurysms[J]. J Neurol Neurosurg Psychiatry, 2013, 84(8): 888-892.
[15]	Harroud A, Crepeau AZ. Epilepsy and mortality after aneurysmal subarachnoid hemorrhage[J]. Neurology, 2017, 89(3): 222-223.
[16]	Watanabe Y, Uotani K, Nakazawa T, et al. Dual-energy direct bone removal CT angiography for evaluation of intracranial aneurysm or stenosis: comparison with conventional digital subtraction angiography[J]. Eur Radiol, 2009, 19(4): 1019-1024.

组别	例数	阳性	阴性
A组	347	23（6.63）	324（93.37）
B组	191	3（1.57）	188（98.43）
χ²值		5.796
P值		0.016

组别	例数	阳性	阴性
A组	347	23（6.63）	324（93.37）
B组	191	3（1.57）	188（98.43）
χ²值		5.796
P值		0.016

组别	例数	疗效			并发症
组别	例数	治愈	好转	无效	颅神经症状	迟发出血
观察组	19	17（89.47）	2（10.53）	0（0）	2（10.53）	0（0）
对照组	274	256（93.43）	14（5.11）	4（1.46）	23（8.39）	3（1.09）
χ²值		0.036	0.233	0.242	0.011	0.518
P值		0.849	0.629	0.622	0.918	0.471

组别	例数	疗效			并发症
组别	例数	治愈	好转	无效	颅神经症状	迟发出血
观察组	19	17（89.47）	2（10.53）	0（0）	2（10.53）	0（0）
对照组	274	256（93.43）	14（5.11）	4（1.46）	23（8.39）	3（1.09）
χ²值		0.036	0.233	0.242	0.011	0.518
P值		0.849	0.629	0.622	0.918	0.471

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