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Liu M, Hou X, Chen F, Li T, Xu Z, Li S, Zhou Y, Wang Y, Xia L, Wang W. Predictive nomogram for hearing deficits after microvascular decompression treatment. Neurosurg Rev 2024; 47:481. [PMID: 39186095 DOI: 10.1007/s10143-024-02716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/14/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
We explored the impact of brainstem auditory evoked potentials monitoring, as well as anatomical characteristics, in relation to their influence on hearing deficits. A total of 851 patients diagnosed with idiopathic hemifacial spasm underwent microvascular decompression treatment were recruited in our study. A nomogram was developed based on the regression analysis. Nomogram performance was evaluated through receiver operating characteristic (ROC), decision curve analyses and calibration curve. The rate of positive wave V change was also higher in the hearing deficit group (71.8% vs no hearing deficit group, p < 0.001). Furthermore, greater retraction depth (0.78 ± 0.25 cm vs 0.55 ± 0.12 cm, p < 0.001), duration (74.43 ± 15.74 min vs 55.71 ± 7.01 min, p < 0.001) and retraction distance (4.38 ± 0.38 cm vs 4.17 ± 0.24 cm, p = 0.001) were evident in the hearing deficit patients. Multivariate logistic regression showed that positive wave V change (OR 5.43), greater retraction depth (OR 55.57) and longer retraction duration (OR 1.14) emerged as significant independent predictors of postoperative hearing deficit. The external validation cohort exhibited a favorable discrimination with an AUC of 0.88. The calibration curves further confirmed the reliability of the predicted outcome in relation to the observed outcome in the external validation cohort (p = 0.89). The decision curves demonstrated that the nomogram outperformed the All or None scheme when the threshold probability ranged from > 2% to < 60% in the external validation cohort. We constructed a nomogram, including wave V, retraction depth, and retraction duration, which can effectively predict the occurrence of hearing deficits and has good clinical applicability.
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Affiliation(s)
- Mingxing Liu
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Xiaoqun Hou
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Feng Chen
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Tong Li
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Zhiming Xu
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Shengli Li
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Yong Zhou
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Yongyi Wang
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China
| | - Lei Xia
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, 1665 KongJiang Rd, Shanghai, 200092, P. R. China.
| | - Weimin Wang
- Department of Neurosurgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), No.1 Jiaozhou Road, Qingdao, Shandong Province, 266011, P.R. China.
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Truong VT, Ngo MQ, Phan D, Le H, Tran Hoang NA. Results from 228 Patients with Hemifacial Spasm Undergoing Microvascular Decompression without Intraoperative Neuroelectrophysiology Monitoring. World Neurosurg 2024; 185:e461-e466. [PMID: 38369107 DOI: 10.1016/j.wneu.2024.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/09/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Intraoperative neuroelectrophysiology monitoring (IONM) has been used to decrease complications and to increase the successful rate of microvascular decompression (MVD) MVD for hemifacial spasm (HFS). Still, it is not available at limited resource centers. We report the outcome of patients undergoing MVD for HFS without using IONM. METHODS The variables concerning the patients' demographics (age and gender), clinical characteristics, offending vessels (vertebral artery type and non-vertebral artery type), postoperative grade of HFS, and postoperative complications of HFS patients undergoing MVD were retrospectively reviewed and collected. The scoring system provided by the Japan Society for MVD was used to evaluate the postoperative outcome of HFS. Postoperative hearing ability was evaluated according to a subjective assessment of the patients. RESULTS A total of 228 patients were recruited. Their median age was 51.0 (44.0-57.0) years old. The total cure effect was observed in 207 (90.8%) patients within the first week after the surgery and in 200 (96.1%) patients in a 2-year follow-up. Permanent hearing disturbance happened in 2 patients (0.9%). No patient had permanent unilateral deafness (0%). No postoperative permanent facial paralysis was reported. CONCLUSIONS MVD without IONM may be performed safely and effectively to treat patients with HFS.
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Affiliation(s)
- Van Tri Truong
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam.
| | - Minh Quan Ngo
- Department of Neurosurgery, Nhan Dan Gia Dinh hospital, Ho Chi Minh City, Vietnam
| | - Duy Phan
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam
| | - Hung Le
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam
| | - Ngoc Anh Tran Hoang
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare system, Ho Chi Minh City, Vietnam
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Zheng X, Zhang B, Shao D, Cai L, Xie S, Li Y, Jiang Z. Fully endoscopic microvascular decompression for hemifacial spasm: a clinical study and analysis. Neurosurg Rev 2024; 47:83. [PMID: 38363437 PMCID: PMC10873216 DOI: 10.1007/s10143-024-02311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/14/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
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.
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Affiliation(s)
- Xialin Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
- School of Continuing Education, Anhui Medical University, Hefei, China
| | - Binbin Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Dongqi Shao
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Longjie Cai
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Shan Xie
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Yu Li
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Zhiquan Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China.
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Park SK, Lee HS, Cho KR, Park K. Recent Advances in Intraoperative Brainstem Auditory Evoked Potential Monitoring during Microvascular Decompression Surgery for Hemifacial Spasm. Life (Basel) 2023; 13:1789. [PMID: 37763193 PMCID: PMC10532422 DOI: 10.3390/life13091789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023] Open
Abstract
Brainstem auditory evoked potential (BAEP) testing during microvascular decompression (MVD) is very important in the treatment of hemifacial spasm (HFS). The reason for this is that the vestibulocochlear nerve is located immediately next to the facial nerve, so the vestibulocochlear nerve may be affected by manipulation during surgery. BAEP testing for detecting vestibulocochlear nerve damage has been further developed for use during surgery. In most HFS patients with normal vestibulocochlear nerves, the degree of vestibulocochlear nerve damage caused by surgery is well-reflected in the BAEP test waveforms. Therefore, real-time testing is the best way to minimize damage to the vestibulocochlear nerve. The purpose of this study was to review the most recently published BAEP test waveforms that were obtained during MVD surgery to determine the relationship between vestibulocochlear nerve damage and BAEP waveforms.
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Affiliation(s)
- Sang-Ku Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea (H.S.L.)
| | - Hyun Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea (H.S.L.)
| | - Kyung Rae Cho
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea (H.S.L.)
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea (H.S.L.)
- Department of Neurosurgery, School of Medicine, Sungkyunkwan University, Seoul 03063, Republic of Korea
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Zhang Y, Zhou E, Xue X, Chen X. Intraoperative brainstem auditory evoked potential monitoring during cerebellopontine angle surgery via retrosigmoid approach. EAR, NOSE & THROAT JOURNAL 2023:1455613221150574. [PMID: 36680392 DOI: 10.1177/01455613221150574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Brainstem auditory evoked potential (BAEP) monitoring was used to identify the influence of auditory function during cerebellopontine angle (CPA) surgery for cranial neuropathy via the retrosigmoid approach. METHODS This prospective study included 20 patients who underwent CPA surgery for cranial neuropathy via the retrosigmoid approach with intraoperative BAEP monitoring and pure tone audiometry (PTA). The latency and interpeak latency were analyzed at each surgical step in combination with the pre- and postoperative PTA. RESULTS Follow-up data were available for 17 patients. The mean pre- and postoperative PTA values were 25.65 dB and 20.70 dB, respectively. Two patients (2/17, 11.76%) developed hearing loss postoperatively. The latency of wave І significantly changed during direct auditory nerve manipulation and at the end of the surgery, while that of wave III only changed during direct auditory nerve manipulation. The appearance of wave V peak was delayed during CPA surgery. CONCLUSIONS CPA surgery for cranial neuropathy via the retrosigmoid approach can cause hearing loss to varying degrees, and intraoperative BAEP monitoring can reduce the occurrence of hearing loss. Intraoperative hearing function can be estimated by the latency of wave I. Hearing loss due to stretching of the brainstem can be estimated by the latency of wave III, and wave V is an early indicator of intraoperative hearing loss. Waves I and III remained stable both pre- and postoperatively, whereas wave V was unstable despite no surgery. Therefore, a precise operation and well-defined operative steps for surgeons during CPA surgery could facilitate maximal preservation of the anatomical structure and function.
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Affiliation(s)
- Yi Zhang
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Enhui Zhou
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Xiaocheng Xue
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Xiaoping Chen
- Department of Otorhinolaryngology, Pudong New Area Gongli Hospital, Shanghai, China
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