Efficacy of microvascular decompression on the vascular compression type of neurogenic hypertension: A meta-analysis

Determining prognostic factors in the treatment of primary hemifacial spasm: Clinical outcomes and complications. A literature review

Objective

Primary Hemifacial Spasm (PHFS) significantly impacts quality of life, necessitating effective treatment like microvascular decompression of the facial nerve. This study aims to identify prognostic factors related to surgical treatment to enhance outcomes and minimize complications. A systematic review of literature from the past five years was conducted.

Methods

Following PRISMA guidelines, we systematically searched databases like PubMed, Embase, Scopus, Ovid, EBSCO, and Cochrane using keywords such as 'Hemifacial spasm,' 'Microvascular decompression,' 'Neurovascular conflict,' and 'Surgical techniques.' The search spanned January 2018 to November 2023. The 'Rayyan' program facilitated data compilation. Each author reviewed abstracts, applying inclusion criteria like systematic reviews, clinical trials, observational studies, and case series, while excluding theoretical or non-English articles.

Results

Of 26 selected articles, those solely addressing PHFS treatment with botulinum toxin and lacking surgical procedure data were excluded. Thus, our analysis focused on 16 articles, including meta-analyses, systematic reviews, clinical trials, and observational studies.

Discussion

Microvascular decompression at the cerebellar pontine angle is the mainstay treatment for hemifacial spasm. Despite limited statistically significant prognostic factors in the literature, overarching recommendations aim to improve outcomes, minimize complications, and prevent recurrences. Key considerations include surgeon expertise, precise techniques, thorough nerve exploration, identifying the conflict's cause, and intraoperative monitoring.

Conclusions

PHFS significantly impacts patients' lives, necessitating timely surgical intervention if initial treatments fail. While statistically significant prognostic factors may be lacking, this study highlights crucial considerations for successful treatment.

Microvascular decompression can effectively reduce arterial blood pressure in patients with Trigeminal Neuralgia

BACKGROUND

Microvascular decompression (MVD) has been used in the treatment of Trigeminal Neuralgia (TN) and arterial hypertension (HTN). Results of several reports have supported its clinical effectiveness, however, little attention has been paid on arterial blood pressure changes caused by MVD in patients with TN.

METHODS

In this single-center retrospective study, a cohort of 80 patients with TN who underwent MVD between 2021 and 2022 had been reviewed. Clinical data such as age, gender, pain duration, operation time, side and range of pain, HTN history, treatment history, VAS score, mean arterial pressure (MAP), and nausea or vomiting after operation were collected and analyzed via Linear regression to select possible related factors. Then, multiple linear regression of the possible predictors was used to identify the variables that significantly predicted MAP reduction.

RESULTS

The VAS scores of TN patients after MVD surgery was significantly lower than that before operation, irrespective of the gender, side and range of pain, HTN history, RF history, and PONV (Wilcoxon test, P < 0.001). MVD can significantly decreased the blood pressure of TN patients, without interference from other factors. (MAP reduction ratio=14.46% ± 12.32%) (paired t-test, P < 0.001). The univariate and Multiple linear regression analysis showed that the preoperative MAP was significantly related to MAP reduction ratio (P < 0.001).

CONCLUSIONS

In patients with TN, MVD can significantly decrease arterial blood pressure. Blood pressure reductions were more prominent when cases with higher preoperative MAP.