The Therapeutic Analysis Of Distinct Offending Vessel In Hemifacial Spasm Microvacular Decompression Operation

ObjectiveMicrovascular decompression for hemifacial spasm is a recognized treatment, thecure rate at home and abroad reported roughly90%. It has been publicly known thatthe domination of medullary root entry zone(REZ) by ectopia vessels might probablycause hemifacial spasm. In order to further improve the efficacy of surgery, this studyat the same time learn from the experience of surgical treatment at home and abroad,we distinguish between the responsible blood vessels and take personalizeddecompression method. Our objective was to study the clinical efficacy ofmicrovascular decompression for hemifacial spasm.Subjects and MethodsSubjects311patients with hemifacial spasm who were operated from January2007to May2009were followed up，230patients were successfully followed up，it included106male patients,124female patients,102left side patients and128right side patients.All of the patients received the preoperative head MRI scanning in order to excludesecondary hemifacial spasm.MethodsGeneral preoperative examination were implemented to get rid of operative taboo,Tip of the rock thin layer MRI were implemented to Clear local vascular compression.Surgery was implemented under general anesthesia, taken the standard sinus access to exposure corresponding facial nerve out the brain stem area (REZ area) andidentify offending vessel under the microscope. According to head MRI and distinctoffending vessel, they were divided into small vascular compression group andvertebral-basal artery complexcompression group, different decompression ways were adopted according to distinctofending vessel. Recorded postoperative and follow-up patients’ surgical effect andcomplications, and implemented the statistical analysis.ResultsThe therapeutic effect was observed at least two years.230patients weresuccessfully followed up, and211cases were cured(91.7%), small vascularcompression group164cases,152cases were cured(92.7%). Vertebral-basal arterycomplex compression group66cases, and59cases were cured(89.4%). Smallvascular compression group has higher heal rate than vertebral-basal arterycompression group. There was no statistically significant difference between cure rate(P>0.05).12cases recurred(5.2%),2cases recurred six months after operation,4cases recurred one to two years after operation,5cases recurred two years afteroperation,1cases recurred three years after operation, small vascular compressiongroup7cases(4.3%), and vertebral-basal artery complex compression group5cases(7.6%);7cases invalid(3.0%), small vascular compression group5cases(3.1%),and vertebral-basal artery complex compression group2cases(3.0%).69cases weredelay cured(30.0%), small vascular compression group43cases(26.2%), andvertebral-basal artery complex compression group26cases(39.4%), there wassignificant statistically difference between delayed cure rate (P <0.05).Vertebral-basal artery compression group has higher delay heal rate. In69delay curedpatients, symptoms of33cases disappeared one month after operation,13cases twomonths after operation,12cases three months after operation,7cases six months after operation,3cases within one year after operation, and1case one year afteroperation.94.8%of delay cured patients had no hemifacial spasm six months afteroperation. The main complications were cranial nerve function damage, and most ofthe patients recovered well.ConclusionThe microvacular decompression operation is the most available treatment tohemifacial spasm. Different decompression ways are adopted according to distinctofending vessel, and all of them have high cure rate. Small vascular compressiongroup has higher heal rate than vertebral-basal artery compression group. There is nostatistically significant difference between cure rate. The causes could bevertebrobasilar arteries compress facial nerve and nerve demyelinated changeseriously, it is difficult for postoperative neurological function to recover fully. Smallblood vessel tension is smaller than vertebrobasilar arteries, blood vessels are easy toshift, and can reduce pressure fully. Vertebral-basal artery compression group hashigher delay heal rate(P<0.05).The causes could be vertebrobasilar arteries compresssmall vessel. Facial nerve demyelinate and facial nerve movement nuclear increasingexcitability are more serious. It needs a long time for the nerve roots to regeneratecompletely and facial nerve movement nuclear excitability to recovery, so there aremore delay cured patients. Postoperative complications are relatively more in thevertebral artery complex oppression, and the difference to be further large sampleresearch. In this study, our experience is that the therapeutic effect is assessed after atleast two years observing and following-up. It is not appropriate for postoperativeconvulsion patients to surgery secondly immediately. Intraoperative careful operationcould reduce the postoperative complications maximumly.