Fully endoscopic versus microscopic vascular decompression for hemifacial spasm: a retrospective cohort study

Fully endoscopic microvascular decompression for hemifacial spasm: a clinical study and analysis

Fully endoscopic microvascular decompression (MVD) of the facial nerve is the main surgical treatment for hemifacial spasm. However, the technique presents distinct surgical challenges. We retrospectively analyzed prior cases to consolidate surgical insights and assess clinical outcomes. Clinical data from 16 patients with facial nerve spasms treated at the Department of Neurosurgery in the First Affiliated Hospital of Bengbu Medical College, between August 2020 and July 2023, were retrospectively examined. Preoperatively, all patients underwent magnetic resonance angiography to detect any offending blood vessels; ascertain the relationship between offending vessels, facial nerves, and the brainstem; and detect any cerebellopontine angle lesions. Surgery involved endoscopic MVD of the facial nerve using a mini Sigmoid sinus posterior approach. Various operative nuances were summarized and analyzed, and clinical efficacy, including postoperative complications and the extent of relief from facial paralysis, was evaluated. Fully endoscopic MVD was completed in all patients, with the offending vessels identified and adequately padded during surgery. The offending vessels were anterior inferior cerebellar artery in 12 cases (75%), vertebral artery in 3 cases (18.75%), and posterior inferior cerebellar artery in 1 case (6.25%). Intraoperative electrophysiological monitoring revealed that the lateral spread response of the facial nerve vanished in 15 cases and remained unchanged in 1 case. Postoperative facial spasms were promptly alleviated in 15 cases (93.75%) and delayed in 1 case (6.25%). Two cases of postoperative complications were recorded-one intracranial infection and one case of tinnitus-both were resolved or mitigated with treatment. All patients were subject to follow-up, with no instances of recurrence or mortality. Fully endoscopic MVD of the facial nerve is safe and effective. Proficiency in endoscopy and surgical skills are vital for performing this procedure.

Unilateral Biportal Endoscopic Discectomy versus Microendoscopic Discectomy for the Treatment of Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Objective

In minimally invasive spinal surgery, the treatment of lumbar spinal stenosis with microendoscopic discectomy (MED) or unilateral biportal endoscopic discectomy (UBED) shows effective results, but which is more effective is controversial. Our study aimed to evaluate the efficacy and safety of UBED versus MED in the treatment of lumbar spinal stenosis by a systematic review and meta-analysis, so as to provide reference for the promotion of UBED in clinical practice.

Methods

The multiple databases like PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Databases, Chinese BioMedical Database, and Wanfang Database were used to search for the relevant studies. Review Manager 5.4 was adopted to estimate the effects of the results among selected articles. Odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were used to estimate the overall pooled effect. Subgroup analysis, forest plots, funnel plots and Egger's test for the articles included were also conducted.

Results

Three randomized clinical trials and seven cohort studies were finally retrieved, these studies included 685 and 829 patients in the UBED and MED groups, respectively. There were no differences in terms of operation time (MD = -0.92, P =0.72), estimated blood loss (MD = -26.31, P =0.08), complications (MD =0.81, P =0.38) and Oswestry Disability Index (ODI) score (P >0.05 in four subgroup) between the two groups. The visual analog scale (VAS) score of back pain in the UBED group was better than MED group only at 6 months (MD = -0.23, P =0.006) after operation, the VAS score of leg pain in the UBED group was better than that of MED group at 3 mouths (MD = -0.22, P =0.002) and 6 months (MD = -0.24, P =0.006) after operation, the UBED group had a less postoperative length of stay than the MED group (MD = -1.85, P <0.001). The bias analysis showed that there was no potential publication bias in the included literature.

Conclusion

This study showed that compared with MED, UBED has the advantages of short hospital stay and good short-term curative effect, but there is no significant difference in long-term efficacy and safety, they can be replaced by each other in clinical application.

Nursing Education of Lateral Oblique Complications of Neurosurgery under Microscope

In order to solve the problem of nursing education of lateral oblique complications, a nursing education solution of lateral oblique complications of neurosurgery under the microscope was proposed. The method used subjective evaluation and objective evaluation to systematically evaluate the basic training module. In subjective evaluation, the authenticity score of surgical simulator was 3.65 ± 0.01, the realism score of surgical instruments was 3.81 ± 0.01, the realism score of tactile sense was 3.75 ± 0.01, the operating environment score was 3.60 ± 0.01, and the overall effect score was 3.63 ± 0.01. The difficulty score of the whole training was 3.15 ± 0.01. In the aspect of objective evaluation, the entropy method was used to process the data of training track, training angle, training time, trigger times, success times, failure times, and other indicators of 24 trainers collected, and the experiment verified the nursing education of lateral oblique complications of neurosurgery under the microscope.

The Efficacy and Safety of <2 cm Micro-Keyhole Microvascular Decompression for Hemifacial Spasm

Objective: Microvascular decompression (MVD) surgery has been accepted as a minimally invasive surgical modality for the treatment of hemifacial spasm (HFS). However, the size of the bone window does not match the concept of minimally invasive. This study is aimed at evaluating the efficacy and safety of <2 cm micro-keyhole MVD.

Methods: A total of 148 patients with HFS diagnosed in the First Affiliated Hospital of Chongqing Medical University from January 1, 2019, to July 1, 2020, who underwent MVD in the neurosurgery department of the hospital were collected. Surgery was performed by a retrosigmoid keyhole approach with the bone hole diameter <2 cm, which was named micro-keyhole MVD. The efficacy and safety of the micro-keyhole MVD were evaluated by statistical analysis of the efficacy of the micro-keyhole MVD and the incidence of postoperative complications.

Results: The effect of micro-keyhole MVD was satisfying (cure or partial remission) in 97.2% (n = 144). The failure and recurrence rates were 2.7% (n = 4) and 0.6% (n = 1), respectively. Among them, immediate facial palsy, delayed facial palsy, hearing loss, and cerebrospinal fluid (CSF) leakage were found in 0.6% (n = 1), 8.1% (n = 12), 4.7% (n = 7), and 1.3% (n = 2). Only one patient developed cerebellar infarction, which was complicated by “moyamoya disease.” The micro-keyhole MVD in the treatment of HFS can achieve a high remission rate and reduce the incidence of surgical complications.

Conclusion: Micro-keyhole MVD is a safe and effective minimally invasive treatment for HFS. This technique does not increase the incidence of cranial nerve injury. Meanwhile, it reduces the incidence of CSF leakage and hearing loss (HL).