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26.10.2017 | Original Article - Neurosurgical Techniques | Ausgabe 1/2018

Acta Neurochirurgica 1/2018

Quantitative study of the correlation between cerebellar retraction factors and hearing loss following microvascular decompression for hemifacial spasm

Zeitschrift:
Acta Neurochirurgica > Ausgabe 1/2018
Autoren:
Ning Li, Wei-Guo Zhao, Chun-Hua Pu, Wen-Lei Yang
Wichtige Hinweise

Comments

The authors present a prospective study in which they quantitatively measured cerebellar retraction factors, including retraction distance, depth and duration, and evaluated their potential relationship to the development of hearing loss after microvascular decompression for hemifacial spasm. Of 110 patients, 11 lost hearing. Compared with the group without hearing loss, the cerebellar retraction distance, depth and duration of the group with hearing loss were significantly greater. Multivariate regression analysis showed that greater cerebellar retraction depth and longer retraction duration were significantly associated with the higher incidence of postoperative hearing impairment. The authors concluded that there is a correlation between cerebellar retraction depth and duration and hearing loss following MVD for HFS.
This is a nice attempt trying to prospectively evaluate the influence of cerebellar retraction on hearing. Although all neurosurgeons who perform MVD for HSF know that cerebellar retraction may quickly lead to changes in the BEAP indicating an increased risk of hearing loss, no prospective study on that topic has been published. One shortcoming is that the authors equate cerebellar retraction duration as the duration of microscopic manipulation defined from the opening of the dura to finishing the Teflon placement. However, there are manipulations during the surgery without cerebellar retraction. Direct manipulation of the hearing nerve and its vascular supply may also lead to hearing impairment. Another drawback of the study is that the measurement of the retraction depth is not in the plane of the dissection. The surgical approach is more in the caudal-to-cranial direction; therefore, the measured cerebellum retraction distance is not the retraction that is actually applied during the surgery. The retraction required to expose the root exit zone of the facial nerve is less.That being said, the authors are to be congratulated for their attempt to quantify the retraction parameters that affect hearing outcome after MVD for hemifacial spasm.
Henry Schroeder,
Greifswald, Germany

Abstract

Background

This prospective study quantitatively measured the cerebellar retraction factors, including retraction distance, depth and duration, and evaluated their potential relationship to the development of hearing loss after microvascular decompression (MVD) for hemifacial spasm (HFS).

Methods

One hundred ten patients with primary HFS who underwent MVD in our department were included into this study. The cerebellar retraction factors were quantitatively measured on preoperative MR and timed during MVD. Associations of cerebellar retraction and other factors to postoperative hearing loss were analyzed.

Results

Eleven (10%) patients developed hearing loss after MVD. Compared with the group without hearing loss, the cerebellar retraction distance, depth and duration of the group with hearing loss were significantly greater (p < 0.05). Multivariate regression analysis showed that greater cerebellar retraction depth and longer retraction duration were significantly associated with a higher incidence of postoperative hearing impairment (p < 0.05).

Conclusion

This study strongly suggested a correlation between the cerebellar retraction factors, especially retraction depth and duration, and possibility of hearing loss following MVD for HFS.

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