Analysis Of Influencing Factors Of Delayed Facial Paralysis After Neuroendoscope Neurovascular Decompression

PURPOSE:Through the retrospective analysis of cases of idiopathic unilateral hemifacial spasm treated by neuroendoscopic neuromicrovascular decompression,the related risk factors of delayed postoperative hemifacial paralysis were discussed,and the related risk factors of reducing postoperative complications were put forward by statistical analysis of clinical data,so as to provide reference for clinical treatment.METHODS:A total of 273 patients receiving MVD in the Department of Neurosurgery of Huaihe Hospital of Henan University from January 1,2014 to December 31,2021 were selected as the subjects who met the inclusion criteria and could complete outpatient or telephone follow-up for more than 18 months.MRI facial nerve primordial imaging was performed in all the patients and primary hemifacial spasm was confirmed.Relevant preoperative examinations were completed and decompression of suboccipito-retrosigmoid approach was performed.The course of disease,preoperative Cohen grade of facial spasm,age,gender,affected side,responsible vessels,and postoperative House-Brackmann grade of facial paralysis were recorded.Follow-up visits were conducted 6,12 and 18 months after surgery.To analyze the risk factors and etiology of delayed facial paralysis before,during and after operation.RESULTS:Univariate analysis showed that the course of disease(P=0.021;P < 0.05),intraoperative facial nerve indentation caused by the compression of the responsible artery(P < 0.001)was a related risk factor for DFP after facial nerve microvascular decompression with facial spasm;At the same time,related risk factors such as age,HFS grade,hypertension,diabetes,affected side,gender,age at onset,and responsible artery were analyzed,and the results showed no significant statistical significance.The correlation analysis of the occurrence time and duration of postoperative facial paralysis showed that the incidence of facial paralysis after facial nerve microvascular decompression was not low,but the prognosis was good.Among the 273 patients undergoing MVD surgery,25 patients developed facial paralysis after surgery.After 1-18 months of follow-up,facial nerve function of all patients was significantly recovered except one patient who had house-Brackmann III postoperative facial paralysis.The duration of facial paralysis was 10-270days(mean 96.6 days).At the end of follow-up,all 25 patients with postoperative facial paralysis had recovered to varying degrees.Statistical analysis showed that the duration of the disease before surgery and the indentation formed by the compression of the responsible artery on the facial nerve were related to the occurrence of facial paralysis.CONCLUSION:The incidence of DFP after MVD with hemifacial spasm was 9.2%(25/273),which was not low,but the prognosis was good.The longer the course of HFS,the more likely DFP will occur after MVD.Intraoperative facial nerve compression caused by facial nerve indentation cases are prone to postoperative facial paralysis.