| Objective: To investigate the curative effect and complications of microvascular decompression in treatment of hemifacial spasm,whether the immediate resolution within 7days of spasm is a prognostic factor of long-term curative effect of MVD,the occurrence of delayed resolution and the prognostic factors of MVD.Methods: Retrospectively analyzed the clinical characteristics and follow-up data(completely recorded)of 159 patients who had hemifacial spasm and underwent microvascular decompression surgery in our center from Aug 2008-May 2016.All patients were treated by the same treatment group,regularly received MRI to exclude a secondary etiology and determine the possible responsible vessel.The surgical approach was followed by the retrosigmoid approach.After the exploration of the responsible vessel,the Teflon cotton pad was separated from the responsible vessels and the facial nerve REZ.After surgery,the patients' facial muscle tic symptoms were observed and recorded,and the possible prognostic factors were analyzed.The collected data focus on symptom relief in a time course: immediately after MVD,7days after MVD and last follow-up(>6months)by using Cohen-Albert grading and the occurrence of delayed resolution.Different outcomes were observed and divided into six categories according to the time course of spasm disappeared.Univariate Logistic regression analysis was used to determine the prognostic factors associated with short-term and long-term outcomes,and to determine the correlation between short-term and long-term outcomes.Results: A total of 159 patients underwent MVD and were followed up for more than6 months.The cure rate was 88.1%(140/159).The symptom relief were recorded immediately after MVD:94 patients were spasm-free,33 patients were grade 1 and 32 patients were grade 2.7 days after MVD: 97 patients were spasm-free,54 patients were grade 1 and 8 patients were grade 2.In the last follow-up: 140 patients were spasm-free,4 patients were grade 1,4 patients were grade 2 and 11 patients were grade 3-4.6 categories according to the time course of spasm disappeared:Type 1:66,Type 2:43,Type 3:7,Type 4:24,Type 5:17,Type 6:2.Postoperative complications:intracranial hypotension in 18 cases,mild to moderate facial palsy in 7 cases,tinnitus in 10 cases,hearing impairment in 6 cases,vertigo in 4 cases,intracranial infection in7 cases,cerebrospinal fluid leakage in 6 cases,subcutaneous effusion in 6 cases,incision infection in 1 case and subarachnoid hemorrhage with intraventricular hemorrhage in 1 case.Compared to persist spasm group within 7 days after MVD,the cure rate was significantly higher in the spasm symptom relief group within 7 days after MVD(p<0.05),the cure rate of MVD(y)and the number of days within 7 days of resolution(x)were highly relevant,y=-0.707x2+9.724x+67.442(p<0.05).By using univariate Logistic regression analysis,we find out that the prognostic factors of long-term curative effect are the symptom relief immediately after MVD and the average symptom scale in the 7 days after MVD(p<0.00001).The incidence of delayed resolution was 47.1%(66/140).Conclusion: For the HFS patients,MVD was safe and effective treatment and the delayed resolution after MVD does exist.In the 7 days after MVD,at least 1 day of relief of symptom predicts a long-term cure of HFS.For those patients' spasm still persist exist or the symptom recur after a transient resolution,should consider whether undergo second operation at least 6months after MVD. |
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