Research of the nimodipine in the prevention of delayed facial palsy after microvascular decompression / 重庆医学

Objective To research the effect of nimodipine in the prevention and treatment of delayed facial palsy after microvas-cular decompression .Methods A retrospective analysis was taken from January 2009 to March 2012 ,193 cases of patients with fa-cial spasm undergoing MVD in our department .According to whether applied vasodilators after operation ,all cases were divided into two groups :the experimental group(72 cases)with the treatment of nimodipine for two weeks ;the control group(121 cases) ,and not treated with nimodipine .The follow-up time was 6-12 months .Observe and compare the incidence ,level of delayed facial paraly-sis onset time and disease duration time between two groups .Results In the experimental group had 6 cases of late facial paralysis , the incidence was 8 .3% (6/72) ,onset time was (14 .5 ± 5 .2)days ,disease duration was (41 .3 ± 14 .4)days .The incidence of control group was 9 .1% (11/121) ,onset time was (12 .2 ± 7 .4)days ,disease duration was (55 .7 ± 36 .4)days .There was no significant difference between groups(P>0 .05) .According to House-Brackman classification ,there were 4 cases of grade Ⅱ and 2 cases of grade Ⅲ in experimental group .In control group ,there were 2 cases of grade Ⅱ ,6 cases of grade Ⅲ ,3 cases of grade Ⅳ .The differ-ence was statistically significant (P<0 .05) .Conclusion The delayed facial paralysis is influenced by a variety of causes .Vasodila-tor drugs can reduce the incidence of delayed facial paralysis ,and play a certain role in promoting facial paralysis restored .

Delayed Cranial Nerve Palsy after Microvascular Decompression for Hemifacial Spasm

OBJECTIVE: Microvascular decompression (MVD) for hemifacial spasm (HFS) is a safe and effective treatment with favorable outcomes. The purpose of this study was to evaluate the incidence of delayed cranirve ( VI, VII, and VIII ) palsy following MVD and its clinical courses. METHODS: Between January 1998 and December 2009, 1354 patients underwent MVD for HFS at our institution. Of them, 100 patients (7.4%) experienced delayed facial palsy (DFP), one developed sixth nerve palsy, and one patient had delayed hearing loss. RESULTS: DFP occurred between postoperative day number 2 and 23 (average 11 days). Ninety-two patients (92%) completely recovered; however, House-Brackmann grade II facial weakness remained in eight other patients (8%). The time to recovery averaged 64 days (range, 16 days to 9 months). Delayed isolated sixth nerve palsy recovered spontaneously without any medical or surgical treatment after 8 weeks, while delayed hearing loss did not improve. CONCLUSION: Delayed cranial nerve (VI, VII, and VIII) palsies can occur following uncomplicated MVD for HFS. DFP is not an unusual complication after MVD, and prognosis is fairly good. Delayed sixth nerve palsy and delayed hearing loss are extremely rare complications after MVD for HFS. We should consider the possibility of development of these complications during the follow up for MVD.

Delayed Facial Palsy Following Microvascular Decompression in Hemifacial Spasm Patients

OBJECTIVE: Microvascular decompression(MVD) for hemifacial spasm(HFS) is well established. However delayed postoperative facial palsy has not been substantially reported. The authors reviewed patients with HFS who underwent MVD in our institution to evaluate the post-operative courses with special attention to the development of delayed facial palsy. METHODS: Records of 144 cases(137 patients) from 1988 to 1997 were reviewed. Of these patients, 12(8.3%) developed delayed facial palsy. Follow-ups via chart and phone records were available for 10 of 12 patients. RESULTS: Reviews of these 12 cases demonstrated that 3 men, 9 women of with average age of 53(range 45-60) had delayed facial palsy. Among them, 2 had repeated operation. The preoperative duration of symptoms averaged 12 years(range 1-30) and 4 patients had mild preoperative weakness. All were improved their HFS within 7 days after MVD. Offending vessels were anterior inferior cerebellar artery(AICA) in 7. Five of these were meatal branches and 2 were sandwich type compressions. One case was combined compression of AICA and posterior inferior cerebellar artery. Three to 7 pieces of Teflon felt were necessary for the decompression of offender. The onset of weakness occurred invariably between postoperative day 6 and 11. Two cases had associated complications. The one was hearing loss and the other was meningitis accompanied by cerebrospinal fluid otorrhea. Ten cases received steroids following the onset of their facial palsies. Duration of follow up of 10 cases was 21months(3months-5years). Three cases showed complete recovery at 4, 8 and 12 weeks, respectively. Four patients have improved to House Grade II at 5 weeks and remaining three showed continuing improvement until last follow-up. CONCLUSIONS: Delayed facial palsy following MVD in HFS patients is not uncommon, being 8.3% in our series. It occurs consistently 1-2 weeks postoperatively. Possible causes include facial nerve exit zone injury with Teflon felt or delayed facial nerve edema. Spontaneous recovery usually occur within several weeks.