Evaluating The Effect Of Microvascular Decompression On Patients With Vertebroarterial Or Non Vertebroarterial Related Hemifacial Spasm:a Meta-analysis

Objective:Systematic evaluation of the effect of microvascular decompression on patients with Vertebroarterial or non Vertebroarterial related hemifacial spasm Methods:Clinical study with the Clinical characteristics,postoperative efficacy and recurrence of microvacular decompression on patients with Vertebroarterial or non Vertebroarterial related hemifacial spasm were searched in EMbase,Cochrane library,Medline,Pub Med,Zhiwang and Wanfang.The retrieval time is set from January 2009 to August 2019.Strictly select the literature according to the inclusion and exclusion criteria,evaluate the quality of the included research and extract relevant data.The Meta-analysis was performed using Rev Man5.3 software.Results:A total of 13 retrospective studies were included,involving 2441 patients who were divided into the experimental group(VA,n=519)and the control group(non VA,n=1922).The Meta-analysis showed that in clinical characteristics,patients with Vertebroarterial related facial spasm are more likely to occur on the left side(OR=3.82,95%CI(2.77-5.27),P<0.00001)than those with non Vertebroarterial related facial spasm,and there is no significant difference in age(MD=0.6,95%CI(-0.76,1.96),P=0.39)and gender(OR=1.81,95%CI(0.94-3.47),P=0.07)between the two groups.In terms of effectiveness,patients with non vertebral artery related facial spasm have higher postoperative efficiency(OR=0.53,95%CI(0.34-0.82),P=0.005)and cure rate(OR=0.61,95%CI(0.39-0.97),P=0.03)and lower postoperative delayed cure rate(OR=1.94,95%CI(1.46-2.59),P<0.00001)than patients with vertebral artery related facial spasm.In terms of safety,patients with Vertebroarterial related facial spasm had higher incidence of total postoperative complications(OR=2.04,95%CI(1.05-3.95),P=0.04),postoperative facial paralysis(OR=2.40,95%CI(1.46-3.94),P=0.0005)and posterior cranial nerve injury(OR=2.59,95%CI(1.18-5.71),P=0.02)than those without Vertebroarterial related facial spasm,but there was no significant difference in the incidence of hearing injury(OR=1.64,95%CI(0.85-3.15),P=0.14)between the two groups.In terms of recurrence rate,patients with Vertebroarterial related facial spasm have a higher postoperative recurrence rate(OR=2.36,95%CI(1.16-4.79),P=0.02)than patients without Vertebroarterial related facial spasm.Conclusion:The effect of microvascular decompression on non vertebral artery related facial spasm is better than that of vertebral artery related hemifacial spasm.