Delayed facial palsy after microvascular decompression for hemifacial spasm: multivariate Logistic regression analysis of influencing factors

doi:10.3969/j.issn.1672-6731.2020.12.012

Abstract

Abstract:

Objective To explore the influencing factors for delayed facial palsy after microvascular decompression for hemifacial spasm. Methods We retrospectively analyzed 306 cases of hemifacial spasm undergoing microvascular decompression. The cases were divided into facial paralysis group and control group according to whether postoperative delayed facial paralysis occurred, comparing gender, age, disease duration, hypertension, diabetes, old cerebral infarction, spasm position, pre-operation Cohen grade, number of responsible vessels, severe indentation between two groups. Single factor and multivariate stepwise Logistic regression analysis were used to determine the risk factors for delayed facial palsy after microvascular decompression. Results Delayed facial palsy occurred in 21 cases (6.86%). House brackmann (H-B) grade Ⅲ in 2 cases, Ⅳ in 17 cases, Ⅴ in 2 cases. Multivariate stepwise Logistic regression analysis showed that disease duration (OR=1.130, 95% CI:1.004-1.271; P=0.042) and severe indentation (OR=0.167, 95%CI:0.056-0.495; P=0.001) were the risk factors for delayed facial palsy after microvascular decompression. During 0.50-5.00 years' follow-up, 19 patients with delayed faoial palsy recovered completely, and 2 patients recovered to H-B grade Ⅱ. Conclusions Severe indentation and disease duration were risk factors for delayed facial palsy after microvascular decompression. Delayed facial palsy is generally self-healing with a good prognosis.

Key words: Spasm, Facial muscles, Microvascular decompression surgery, Facial paralysis, Postoperative complications, Logistic models

摘要：

目的探讨面肌痉挛微血管减压术后并发迟发性面瘫的影响因素。方法回顾分析2014年3月至2019年3月接受微血管减压术的面肌痉挛患者临床资料，比较迟发性面瘫组（面瘫组）和对照组患者性别、年龄、病程、高血压、糖尿病、陈旧性脑梗死、面肌痉挛位置、术前面肌痉挛程度（Cohen分级）、责任血管数量及面神经压痕等差异，采用单因素和多因素逐步法Logistic回归分析术后迟发性面瘫危险因素。结果本组306例患者中共21例（6.86%）于术后（11.40±3.62）天发生迟发性面瘫，其中House-Brackmann（H-B）分级Ⅲ级2例、Ⅳ级17例、Ⅴ级2例。多因素逐步法Logistic回归分析提示，长病程（OR=1.130，95% CI：1.004~1.271；P=0.042）、面神经压痕明显（OR=0.167，95% CI：0.056~0.495；P=0.001）是微血管减压术后迟发性面瘫的危险因素。随访0.50~5.00年，其中19例自愈，面神经功能恢复至正常状态（H-B分级Ⅰ级）；2例恢复达到Ⅱ级。结论病程长、面神经压痕明显是面肌痉挛微血管减压术后迟发性面瘫的危险因素，患者多可自愈，预后良好。

关键词: 痉挛, 面部肌肉, 微血管减压术, 面神经麻痹, 手术后并发症, Logistic模型

GUAN Yu-hua, ZHENG Gang, LI Gang, CHEN Shao-jun. Delayed facial palsy after microvascular decompression for hemifacial spasm: multivariate Logistic regression analysis of influencing factors[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(12): 1099-1103.

管玉华, 郑刚, 李刚, 陈少军. 面肌痉挛微血管减压术后迟发性面瘫影响因素分析[J]. 中国现代神经疾病杂志, 2020, 20(12): 1099-1103.

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URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2020.12.012

https://journal11.magtechjournal.com/cjcnn/EN/Y2020/V20/I12/1099

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