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Association study of the pneumatization degree of mastoid air cells and postoperative complications after microvascular decompression in hemifacial spasm

  • Original Article - Functional Neurosurgery - Movement disorders
  • Published:
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Abstract

Background

This study aimed to analyse the association between the degree of pneumatization of mastoid air cells (MACs) and postoperative complications after microvascular decompression in hemifacial spasm.

Methods

We retrospectively reviewed 308 patients with hemifacial spasm who underwent surgery at our institute between January 2017 and March 2021. The degree of pneumatization of MACs was classified into four grades (grades 1, 2, 3, and 4) according to method of Han et al. The clinical data of the four grades were analysed and statistically examined.

Results

There were no statistically significant differences between the four grades in terms of the operative time, intraoperative blood loss, and postoperative hospital stay (all, P > 0.05). The incidence of hearing loss was higher in grade 4 MACs (26.56%) than in grades 1 and 2 MACs (5.41% and 2.89%, respectively; P < 0.05). The incidence of facial paralysis was higher in grade 4 MACs (28.13%) than in grades 1 and 2 MACs (5.41% and 9.18%, respectively; P < 0.001). The incidence of intracranial infection was higher in grade 3 MACs (17.65%) than in grade 2 MACs (3.89%) (P < 0.05). All four patients with cerebrospinal fluid leakage belonged to grade 4 MACs. The incidence of cerebrospinal fluid leakage was higher in grade 4 MACs (5.13%) than in grade 2 MACs (P < 0.05).

Conclusions

This study found that the degree of pneumatization of MACs was closely related to the postoperative complications after MVD surgeries. Well-pneumatized MACs increase the risk of cerebrospinal fluid leakage and intracranial infection. However, insufficient exposure increases the risk of facial paralysis and hearing loss. For patients with well-pneumatized MACs, sufficient surgical exposure is the top priority when locating the bone hole. For those who may have a latent MAC opening, preventive occlusion should be considered.

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Data availability

The datasets generated during and analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

MACs:

Mastoid air cells

HFS:

Hemifacial spasm

MVD:

Microvascular decompression

CT:

Computed tomography

References

  1. Arlt F, Trantakis C, Krupp W, Renner C, Winkler D, Strauss G, Meixensberger J (2011) Cerebrospinal fluid leak after microsurgical surgery in vestibular schwannomas via retrosigmoidal craniotomy. Neurol Res 33:947–952. https://doi.org/10.1179/1743132811y.0000000042

    Article  CAS  PubMed  Google Scholar 

  2. Bartindale M, Kircher M, Adams W, Balasubramanian N, Liles J, Bell J, Leonetti J (2018) Hearing loss following posterior fossa microvascular decompression: a systematic review. Otolaryngol Head Neck Surg 158:62–75. https://doi.org/10.1177/0194599817728878

    Article  PubMed  Google Scholar 

  3. Bayazit YA, Celenk F, Duzlu M, Goksu N (2009) Management of cerebrospinal fluid leak following retrosigmoid posterior cranial fossa surgery. ORL J Otorhinolaryngol Relat Spec 71:329–333. https://doi.org/10.1159/000272030

    Article  PubMed  Google Scholar 

  4. Becker SS, Jackler RK, Pitts LH (2003) Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otol Neurotol 24:107–112. https://doi.org/10.1097/00129492-200301000-00021

    Article  PubMed  Google Scholar 

  5. Belykh E, Onaka NR, Zhao X, Cavallo C, Yağmurlu K, Lei T, Byvaltsev VA, Preul MC, Nakaji P (2018) Endoscopically assisted targeted keyhole retrosigmoid approaches for microvascular decompression: quantitative anatomic study. World Neurosurg 119:e1–e15. https://doi.org/10.1016/j.wneu.2018.04.218

    Article  PubMed  Google Scholar 

  6. Bernardo A, Boeris D, Evins AI, Anichini G, Stieg PE (2014) A combined dual-port endoscope-assisted pre- and retrosigmoid approach to the cerebellopontine angle: an extensive anatomo-surgical study. Neurosurg Rev 37:597–608. https://doi.org/10.1007/s10143-014-0552-8

    Article  PubMed  Google Scholar 

  7. Chaudhry N, Srivastava A, Joshi L (2015) Hemifacial spasm: the past, present and future. J Neurol Sci 356:27–31. https://doi.org/10.1016/j.jns.2015.06.032

    Article  PubMed  Google Scholar 

  8. da Silva EB Jr, Leal AG, Milano JB, da Silva LF Jr, Clemente RS, Ramina R (2010) Image-guided surgical planning using anatomical landmarks in the retrosigmoid approach. Acta Neurochir 152: 905-910. https://doi.org/10.1007/s00701-009-0553-5

  9. El Damaty A, Rosenstengel C, Matthes M, Baldauf J, Dziemba O, Hosemann W, Schroeder HWS (2017) A new score to predict the risk of hearing impairment after microvascular decompression for hemifacial spasm. Neurosurgery 81:834–843. https://doi.org/10.1093/neuros/nyx111

    Article  PubMed  Google Scholar 

  10. Feng BH, Zhong WX, Li ST, Wang XH (2020) Fully endoscopic microvascular decompression of the hemifacial spasm: our experience. Acta Neurochir 162:1081–1087. https://doi.org/10.1007/s00701-020-04245-5

    Article  PubMed  Google Scholar 

  11. Fukunaga A, Shimizu K, Yazaki T, Ochiai M (2013) A recommendation on the basis of long-term follow-up results of our microvascular decompression operation for hemifacial spasm. Acta Neurochir 155:1693–1697. https://doi.org/10.1007/s00701-013-1724-y

    Article  PubMed  Google Scholar 

  12. Han SJ, Song MH, Kim J, Lee WS, Lee HK (2007) Classification of temporal bone pneumatization based on sigmoid sinus using computed tomography. Clin Radiol 62:1110–1118. https://doi.org/10.1016/j.crad.2007.04.019

    Article  PubMed  Google Scholar 

  13. Huang J, Zhan Y, Li Y, Jiang L, Wang K, Wu Z, Xie Y, Shi Q (2021) The efficacy and safety of <2 cm micro-keyhole microvascular decompression for hemifacial spasm. Front Surg 8:685155. https://doi.org/10.3389/fsurg.2021.685155

    Article  PubMed  PubMed Central  Google Scholar 

  14. Huh R, Han IB, Moon JY, Chang JW, Chung SS (2008) Microvascular decompression for hemifacial spasm: analyses of operative complications in 1582 consecutive patients. Surg Neurol 69:153–157. https://doi.org/10.1016/j.surneu.2007.07.027 (discussion 157)

    Article  PubMed  Google Scholar 

  15. Inoue T, Shitara S, Shima A, Goto Y, Fukushima T (2021) Double collagen matrix grafting for dural closure in microvascular decompression: an alternative use of autologous fascial grafting. Acta Neurochir. https://doi.org/10.1007/s00701-021-04856-6

    Article  PubMed  Google Scholar 

  16. Khan SA, Laulloo A, Vats A, Nath F (2020) Microvascular decompression: incidence and prevention of postoperative CSF leakage in a consecutive series of 134 patients. Br J Neurosurg 34:416–418. https://doi.org/10.1080/02688697.2020.1749989

    Article  PubMed  Google Scholar 

  17. Lee MH, Jee TK, Lee JA, Park K (2016) Postoperative complications of microvascular decompression for hemifacial spasm: lessons from experience of 2040 cases. Neurosurg Rev 39:151–158. https://doi.org/10.1007/s10143-015-0666-7 (discussion 158)

    Article  PubMed  Google Scholar 

  18. Lin J, Zhang Y, Peng R, Ji X, Luo G, Luo W, Wang M, Zhu M, Sun X, Zhang Y (2019) Preoperative imaging and microscopic navigation during surgery can avoid unnecessarily opening the mastoid air cells through craniotomy using the retrosigmoid approach. World Neurosurg 121:e15–e21. https://doi.org/10.1016/j.wneu.2018.08.181

    Article  PubMed  Google Scholar 

  19. Luryi AL, Schutt CA, Michaelides E, Kveton JF (2020) Hydroxyapatite cement cranioplasty for translabyrinthine surgery: a single institution experience. Laryngoscope 130:206–211. https://doi.org/10.1002/lary.27907

    Article  CAS  PubMed  Google Scholar 

  20. Magnan J (2018) Endoscope-assisted decompression of facial nerve for treatment of hemifacial spasm. Neurochirurgie 64:144–152. https://doi.org/10.1016/j.neuchi.2018.01.007

    Article  CAS  PubMed  Google Scholar 

  21. Mizobuchi Y, Nagahiro S, Kondo A, Arita K, Date I, Fujii Y, Fujimaki T, Hanaya R, Hasegawa M, Hatayama T, Hongo K, Inoue T, Kasuya H, Kobayashi M, Kohmura E, Matsushima T, Masuoka J, Morita A, Munemoto S, Nishizawa S, Okayama Y, Sato K, Shigeno T, Shimano H, Takeshima H, Tanabe H, Yamakami I (2021) Prospective, multicenter clinical study of microvascular decompression for hemifacial spasm. Neurosurgery 88:846–854. https://doi.org/10.1093/neuros/nyaa549

    Article  PubMed  Google Scholar 

  22. Montava M, Rossi V, CurtoFais CL, Mancini J, Lavieille JP (2016) Long-term surgical results in microvascular decompression for hemifacial spasm: efficacy, morbidity and quality of life. Acta Otorhinolaryngol Ital 36:220–227. https://doi.org/10.14639/0392-100x-899

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Nagata Y, Watanabe T, Nagatani T, Takeuchi K, Chu J, Wakabayashi T (2017) The multiscope technique for microvascular decompression. World Neurosurg 103:310–314. https://doi.org/10.1016/j.wneu.2017.04.059

    Article  PubMed  Google Scholar 

  24. Park K, Hong SH, Hong SD, Cho YS, Chung WH, Ryu NG (2009) Patterns of hearing loss after microvascular decompression for hemifacial spasm. J Neurol Neurosurg Psychiatry 80:1165–1167. https://doi.org/10.1136/jnnp.2007.136713

    Article  CAS  PubMed  Google Scholar 

  25. Sindou M, Mercier P (2018) Microvascular decompression for hemifacial spasm: outcome on spasm and complications. A Review Neuro-Chirurgie 64:106–116. https://doi.org/10.1016/j.neuchi.2018.01.001

    Article  CAS  PubMed  Google Scholar 

  26. Stieglitz LH, Giordano M, Gerganov V, Raabe A, Samii A, Samii M, Lüdemann WO (2010) Petrous bone pneumatization is a risk factor for cerebrospinal fluid fistula following vestibular schwannoma surgery. Neurosurgery 67:509–515. https://doi.org/10.1227/NEU.0b013e3181f88884

    Article  PubMed  Google Scholar 

  27. Takemura Y, Inoue T, Morishita T, Rhoton AL Jr (2014) Comparison of microscopic and endoscopic approaches to the cerebellopontine angle. World Neurosurg 82:427–441. https://doi.org/10.1016/j.wneu.2013.07.013

    Article  PubMed  Google Scholar 

  28. Tamura R, Tomio R, Mohammad F, Toda M, Yoshida K (2018) Analysis of various tracts of mastoid air cells related to CSF leak after the anterior transpetrosal approach. J Neurosurg 130:360–367. https://doi.org/10.3171/2017.9.Jns171622

    Article  PubMed  Google Scholar 

  29. Wang Y, Li Z, Cao X, Zhou C, Jin Y (2020) Postoperative antibiotic management strategy for febrile patient with posterior cranial fossa tumor resection: retrospective clinical study. J Clin Neurosci 80:80–86. https://doi.org/10.1016/j.jocn.2020.07.066

    Article  CAS  PubMed  Google Scholar 

  30. Yamazaki D, Kobayashi M, Hirata S, Terano N, Wakiya K, Fujimaki T (2020) Natural dural defect of the posterior fossa dura as a risk factor for postoperative cerebrospinal fluid leakage. World Neurosurg 142:e229–e232. https://doi.org/10.1016/j.wneu.2020.06.165

    Article  PubMed  Google Scholar 

  31. Yanagawa T, Hatayama T, Harada Y, Sato E, Yamashita K, Tanaka M, Torii M, Kiyomoto M, Imai H, Ehara T, Kono T (2020) Preoperative risk assessment for predicting the opening of mastoid air cells in lateral suboccipital craniotomy for microvascular decompression. Clin Neurol Neurosurg 189:105624. https://doi.org/10.1016/j.clineuro.2019.105624

    Article  PubMed  Google Scholar 

  32. Ying T, Thirumala P, Gardner P, Habeych M, Crammond D, Balzer J (2015) The incidence of early postoperative conductive hearing loss after microvascular decompression of hemifacial spasm. J Neurolog Surg B Skull Base 76:411–415. https://doi.org/10.1055/s-0034-1390402

    Article  Google Scholar 

  33. Zhang Y, Ren H, Jia G, Zhang L, Fan G, Bi Q, Yu Y (2020) Predictive values of maximum changes of brainstem auditory evoked potentials during microvascular decompression for hemifacial spasm. Acta Neurochir 162:2823–2832. https://doi.org/10.1007/s00701-020-04379-6

    Article  PubMed  Google Scholar 

  34. Zhao H, Zhang X, Tang YD, Zhang Y, Ying TT, Zhu J, Li ST (2017) Operative complications of microvascular decompression for hemifacial spasm: experience of 1548 cases. World Neurosurg 107:559–564. https://doi.org/10.1016/j.wneu.2017.08.028

    Article  PubMed  Google Scholar 

  35. Zhi M, Lu XJ, Wang Q, Li B (2017) Application of neuroendoscopy in the surgical treatment of complicated hemifacial spasm. Neurosciences (Riyadh, Saudi Arabia) 22:25–30. https://doi.org/10.17712/nsj.2017.1.20150567

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Jianxin Zhou, Quanhong Shi, Li Jiang, Yanfeng Xie, Bo Deng & Yan Zhan

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  1. Jianxin Zhou
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  2. Quanhong Shi
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  3. Li Jiang
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  4. Yanfeng Xie
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  6. Yan Zhan
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Contributions

Jianxin Zhou and Yan Zhan contributed to conception and designed research; Li Jiang, Quanhong Shi, and Bo-Deng organized the database and performed the statistical analysis; Jianxin Zhou wrote the first draft of the manuscript; Yan Zhan was responsible for final revision; and Yanfeng Xie, Quanhong Shi, Bo Deng, and Li Jiang wrote the sections of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yan Zhan.

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Ethical approval

Ethical approval was waived by the Local Ethics Committee of The First Affiliated Hospital of Chongqing Medical University in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.

Informed consent

All patients provided written informed consent to undergo the procedures. The data are anonymous, and the requirement for informed consent was therefore waived.

Conflict of interest

The authors declare no competing interests.

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This article is part of the Topical Collection on Functional Neurosurgery—Movement disorders

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Zhou, J., Shi, Q., Jiang, L. et al. Association study of the pneumatization degree of mastoid air cells and postoperative complications after microvascular decompression in hemifacial spasm. Acta Neurochir 164, 1543–1550 (2022). https://doi.org/10.1007/s00701-022-05155-4

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  • DOI: https://doi.org/10.1007/s00701-022-05155-4

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