Combined Hyperactive Dysfunction Syndrome Of The Cranial Nerves:a Study Of Clinical Characteristics And Treatment In 44 Patients

Objective Combined hyperactive dysfunction syndrome(HDS)is defined as the combination symptoms arising from over activity in cranial nerves specifically,trigeminal neuralgia(TN),hemi facial spasm(HFS),and gloss pharyngeal neuralgia(GPN)without an obvious explanatory structural lesion.The present study aims to retrospectively analyze the clinical characteristics of all cases of combined HDS treated with microvascular decompression(MVD)in a single institution.Background Combined HDS rarely occurs,and systematic investigations on the subjects are rarely conducted.Methods A total of 1450 patients with HDS were treated with MVD in our department during a 10-year period,among which 44 cases of combined HDS,1030 cases of TN,310 cases of HFS,and 66 cases of GPN were identified.For the 44 cases of combined HDS,operative findings and surgical outcomes were reviewed.For comparison,information regarding age,sex,blood pressure,blood glucose level,blood cholesterol level,as well as postoperative complication of 44 cases of combined HDS and 1406 cases of single HDS,were also obtained from the medical records.Results Combined HDS comprised 3.03%(44/1450)of all HDS in our series,with female predominance compared with single HDS[88.6%(39/44)vs.66.9%(940/1406),p=0.002],including combined TN-HFS(14 cases),combined TN-GPN(26 cases),bilateral TN(2 cases),and combined TN-HFS-GPN(2 cases).The average age at diagnosis of combined HDS(60.9 y)was significantly older than that of single HDS(53.5 y),p=0.035.Hypertension[40.9%(18/44)vs.23.8%(335/1406),p=0.009]was closely associated with the prevalence of combined HDS compared with single HDS.The most common offending vessels were superior cerebellar artery(21/44)in TN,anterior inferior cerebellar artery(7/16)in HFS,posterior inferior cerebellar(12/28)in GPN;no significant difference in the incidence of these offending vessels was indicated between combined HDS and single HDS(p>0.05).The curative rate was 97.7%(43/44)after MVD,and the recurrence rate was 3.33%(3 cases of TN)during follow-up.The incidence rates of postoperative cardiac[6.81%(3/44)vs.1.78%(25/1406),p=0.050],pulmonary[6.81%(3/44)vs.1.35%(19/1406),p=0.027],thromboembolic[4.55%(2/44)vs.0.57%(8/1406),p=0.035],and delirium[27.2%(12/44)vs.14.9%(209/1406),p=0.024]complications were higher in combined HDS than in single HDS.Conclusions Combined HDS is an uncommon syndrome that usually occurs in females,and the most common types are combined TN-GPN.Given that combined HDS tend to occur in elderly patients,surgeons should pay more attention to certain potential postoperative complications,such as postoperative cardiac,pulmonary delirium complications.Nevertheless,with excellent surgical outcomes considered,MVD could still be a favorable treatment choice for combined HDS.