MedNexus
Volume 34 · Issue 01 · 2018
MedNexus
After 13 years, the fourth edition of "WHO Endocrine Tumor Classification" was published in June 2017, and the pituitary tumor classification finally ushered in an update[
Medical-related ventriculitis and meningitis are common complications of neurosurgery, which seriously affect the prognosis and outcome of patients. Although most patients have an acute onset during hospitalization, a few still develop delayed infection even years after discharge. To date, the results of neurological and surgical treatments for medical-related ventriculitis and meningitis have not been satisfactory[
To design and practice standardized treatment protocols of large vestibular schwannomas (VS) based on the strategy of multidisciplinary treatment (MDT), and to discuss its clinical outcomes.
We analyzed all cases of unilateral large VS pathologically confirmed who underwent MDT at Department of Neurosurgery, Huashan Hospital, Fudan University from January 2010 to March 2016. Tumors with the maximal diameter longer than 3 cm were defined as large. The clinical data and follow-up results were retrospectively reviewed. A total of 266 VS patients were enrolled into this study. Electrophysiological monitoring, psychology assessment and facial nerve rehabilitation training were performed for all patients. One-stage anastomosis was applied for broken facial nerve.
Gross total resection of the tumor was achieved in 261 patients (98.1%), near-total resection in 5 patients (1.9%), and the mortality rate was 0%. Facial nerve was anatomically preserved in 248 cases (93.2%). The function of facial nerve was evaluated according to House-Brackmann (H-B) scale, which showed that 125 patients (47.0%) were in grade Ⅰ-Ⅱ, 70 cases (26.3%) in grade Ⅲ, 71 cases (26.7%) in grade Ⅳ-Ⅵ within 1 month (short-term outcome). Perioperative complications included disequilibrium (10.1%), intracranial infection (8.6%), tinnitus (4.1%), lower cranial nerve injury (2.6%) and cerebrospinal fluid leak (1.1%). Follow-up data were available for 252 out of 266 patients (94.7%). For short-term facial outcome of 252 patients, there were 119 cases (47.2%) in grade Ⅰ-Ⅱ, 68 cases (27.0%) in grade Ⅲ, 65 cases (25.8%) in grade Ⅳ-Ⅵ. Meanwhile, long-term facial outcome showed that 184 patients (73.0%) were in grade Ⅰ-Ⅱ, 36 cases (14.3%) in grade Ⅲ, and 32 cases (12.7%) in grade Ⅳ-Ⅵ (P<0.01). There were 193 cases with serviceable hearing before surgery, of whom 60 cases showed serviceable hearing after surgery. The hearing preservation rate was 31.1%.
The MDT strategy for large VS could help improve the gross total resection rate and protect cranial nerve function. In addition, it might reduce perioperative mortality and the incidence of complications.
To discuss the assistance with multimodal image fusion technology in surgery of vestibular schwannomas to improve the rate of total resection as well as preservation of nerve function and achieve precise surgical treatment.
This retrospective study involved 30 patients who underwent surgical treatment of vestibular schwannomas with the assistance of multimodal image fusion at Neurosurgery Department of PLA General Hospital from January 2016 to August 2016. The facial nerve was reconstructed through Fast Imaging Employing Steady State Acquisition With Cycled Phases (FIESTA-C) and Diffusion Tensor Imaging (DTI), and the accuracy of reconstructed facial nerve was verified by intraoperative findings under microscope. The images of facial nerve, internal auditory canal water imaging and temporal bone CT were 3D-reconstructed and fused to determine the relationship between tumors and surrounding structures. CT navigation was used to determine the exact location of posterior wall of the internal auditory canal and areas to be removed. Continuous intraoperative neuroelectrophysiological monitoring was conducted to determine the location of the nerve to avoid its injury.
Total tumor resection was achieved in 28 cases (93.3%) and subtotal resection in 2 cases (6.7%). The anatomical integrity of facial nerve was preserved in 28 cases (93.3%), and 26 cases (86.7%) had excellent or good facial functions. The successful rate of facial nerve reconstruction was 100%, and 93.3% of all patients demonstrated consistence between reconstructed and actual positions of the nerve. Navigation was performed in 17 patients with the registration error ranging from 0.30 mm to 0.92 mm (mean: 0.47±0.15 mm). None of the patients had preoperative functional hearing, and no one retained or improved hearing postoperatively. During the perioperative period, there was no death, cerebrospinal fluid leakage, intracranial hematoma or lower cranial nerve palsy.
The application of multimodal image fusion in surgical treatment of acoustic neuromas could improve the rates of total resection and facial function retention and help reduce operative complications.
To investigate the surgical outcomes and techniques of middle fossa (MF) approach for resection of intracanalicular vestibular schwannomas.
Ten patients diagnosed with intracanalicular vestibular schwannoma underwent surgery treatment through MF approach at Department of Neurosurgery, Tangdu Hospital, Airforce Military Medical University from January 2012 to December 2015. The effects of surgery on hearing and facial nerve functions were assessed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification and House-Brackmann (H-B) grading system, respectively.
All patients achieved complete resection of tumor. Intracranial infection occurred in 1 case. There was no death or cerebrospinal fluid (CSF) leakage. The MRI results at 6-12 months post surgery suggested no recurrence of tumor. The rate of postoperative effective hearing (class A/B) preservation was 4/5, and the rate of functional facial nerve (class Ⅰ/Ⅱ) preservation rate was 9/10.
For intracanalicular vestibular schwannomas, microsurgery via the MF approach could offer good preservation of hearing and facial nerve functions. Being familiar with the anatomy and techniques of MF approach would help to reduce the operative complications.
To investigate the factors influencing facial nerve function after excision of Koos grade 3 and 4 vestibular schwannomas.
A retrospective analysis was conducted on 72 cases of Koos grade 3 and 4 vestibular schwannomas admitted to Department of Neurosurgery at General Hospital of Tianjin Medical University General from June 2013 to May 2016, which were followed up for 12-48 months. According to the House-Brackmann classification of facial nerve function assessed at 1 year after operation, the patients were divided into two groups (Group A: H-B Ⅰ-Ⅱ, Group B: H-B Ⅲ-Ⅵ) to evaluate the facial nerve function and analyzing the influencing factors.
A total of 53 patients belonged to Group A and 19 cases were in Group B at 1 year after operation. The tumor size(OR=2.538, 95%CI: 1.231-5.231, P=0.012), cysts(OR=6.209, 95%CI: 1.635-23.582, P=0.007) and facial nerve displacement(type vs. type 1: OR=6.103, 95%CI: 1.218-30.586, P=0.028) were significantly different (all P<0.05) between the two groups. Multivariate logistic regression analysis showed that tumor size, cysts and facial nerve displacement were highly predictive factors for postoperative facial function (r=0.499, P<0.05). Facial nerve function was better in cases with small tumors, non-cystic tumors and anterior facial nerve displa-cement (type 1).
Tumor size, cysts and facial nerve displacement are important factors that influence postoperative facial nerve function in cases of Koos grade 3 and 4 (large and medium-sized) vestibular schawannomas. Accurate preoperative assessment is beneficial to the protection and recovery of facial nerve function.
To investigate the preliminary effect of refined transotic approach in acoustic neuroma surgery.
The clinical data of 8 patients with acoustic neuromas were enrolled into this retrospective study who underwent operation via modified transotic approach at Department of Otorhinolaryngology, Beijing Tiantan Hospital, Capital Medical University from March 2017 to August 2017. Intracranial hemorrhage was excluded by cranial CT at 6 hours post operation, and MRI was performed for observation of the residual tumor 1 week post operation. The facial nerve function was evaluated according to the House-Brackmann (H-B) classification system in all patients who were followed up at the outpatient clinic.
All 8 patients had complete resection of the tumor. The facial nerve structure was preserved. According to the results of CT and MRI examinations, there was no intracranial hemorrhage or residual tumor in the patients. After surgery, all patients were single-sided deaf. Five patients experienced vertigo, which was relieved after treatment. There was no cerebrospinal fluid leakage or other severe complications such as intracranial infection, hemiplegia and death. All patients were followed up for 2 weeks to 5 months with an average of 10.3±7.2 weeks. Postoperative facial nerve function was assessed by the H-B classification system, which suggested that 3 patients were grade Ⅰ, 3 patients were grade Ⅱ, 1 patient was grade Ⅲ, and 1 patient was grade Ⅳ.
Refined transotic approach could facilitate the radical removal of tumor on the basis of intact cochlear structures and help with preservation of facial nerve and reduction of surgical complications such as cerebrospinal fluid leakage.
To investigate the clinical outcome of microsurgical resection of acoustic neuromas via suboccipital retrosigmoid approach with the assistance of multimodal techniques.
The clinical data of 204 patients with acoustic neuromas were retrospectively analyzed who were admitted to Neurosurgery Department at the First Affiliated Hospital of Chongqing Medical University from September 2010 to September 2016. A total of 48 patients were treated with the assistance of multimodal techniques (multimodal group), and conventional surgical procedures were performed in 156 patients (conventional group). The extent of tumor resection was scored according to enhanced-MRI imagine at 1 week post surgery, the function of facial nerve was evaluated according to House-Brackmann (H-B) scale at 2 weeks following surgery, and the function of acoustic nerve was assessed based on American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification scale at 2 weeks post surgery. All patients were followed up in outpatient clinic and arranged for radiological (MRI) follow-up in 3 months, 6 months and 1 year after surgery. The function of facial nerve was evaluated 6 months after surgery. Comparisons of clinical features, surgical outcome and postoperative complications were conducted between two groups.
The difference between two groups with regard to sex, age, course of diseae, tumor location, tumor size classification, facial nerve function classification and hearing classification was not statistically significant (all P>0.05). The rate of total tumor removal after surgery between two groups was not statistically significant [multimodal group: 95.8% (46/48), conventional group: 92.3% (144/156), P=0.527]. The rate of facial nerve functional preservation evaluated 2 weeks after surgery in the multimodal group was much higher than that the conventional group [81.3% (39/48) vs 64.5% (100/155), P=0.007]. The difference of practical hearing preservation between two groups was not statistically significant [6.3% (3/48) vs 5.8% (9/156), P=0.901]. The multimodal group had lower incidence of postoperative complications compared with conventional group [29.2% (14/48) vs 46.4% (72/155), P=0.034]. The follow-up period of 201 patients ranged from 6 months to 80 months, mean 22.3±4.5 months. The head enhanced MRI showed no tumor recurrence between two groups.The rate of facial nerve functional preservation evaluated 6 months after surgery in the multimodal group was much higher than the conventional group [85.4%(41/48) vs 69.3%(106/153), P=0.009].
The multimodal technology is effective in assisting the resection of acoustic neuromas, which has certain advantages over the conventional method with respect to facial nerve functional preservation and reduction of postoperative complications.
To discuss the clinical features, treatment and outcomes of primary spinal anaplastic ependymomas (PSAE).
Between January 2008 and October 2015, a series of patients with PSAE were surgically managed at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University and enrolled into this retrospective study. This series included 11 consecutive patients (6 females and 5 males) accounting for 1.4% (11/765) of all case of spinal ependymomas during the same period. The average age at presentation was 22.7 ± 12.4 years (range: 8-44 years). The mean preoperative course was 3 months (range: 1.5-18.0 months). All those lesions were surgically treated and pathologically verified.
Gross total resection was achieved in 10 patients, and subtotal resection in 1 patient. Six patients received adjuvant radiation therapy and 1 patient received chemotherapy. During the follow-up lasting an average of 48.9±7.9 months (range: 17-110 months), excellent outcome was achieved in 4 cases, 3 remained stable and 4 deteriorated including 2 died. Five patients developed recurrence after 25.0 ± 7.2 months (range: 4-39 months), and 3 patients underwent a second operation.
PSAE seems to be a type of rare high-grade ependymomas and characterized by short preoperative course, fast progress, high rate of recurrence and poor outcome.
To explore the feasibility, safety and effectiveness of the stenting treatment for acute ischemic stroke (AIS) with extracranial or intracranial arterial stenosis.
A retrospective study was conducted about 29 consecutive patients who underwent stenting operation at Department of Neurosurgery, Jinan Central Hospital Affiliated to Shandong University between April 2014 and October 2016. All patients were diagnosed as AIS. Occlusion or stenosis of related arteries was determined by digital subtraction angiography (DSA), and severe stenosis remained after stent thrombectomy. The NIHSS (National Institute of Health Stroke Scale) scores were documented pre- and postoperatively, and recurrence rates of stroke and transient ischemic attack (TIA) within 30 days and mRS (modified Rankin scale) outcome of 90 days were studied.
The technical success rate was 100%. The mean rate of post-stenting residual stenosis was (10.4±8.1)%. The mean follow-up period was 3 months, and all patients were followed up. One patient had stroke within 30 days. The mean NIHSS scores were 19.5±3.5 (preoperatively) and 5.8±2.1 (postoperatively), which had significant difference (P<0.05). At 90-day follow-up, the mortality rate was 0% and 28 cases (97%) reported the mRS of no more than 2 which suggested good outcomes.
The complication rate of stenting in patients with AIS and cerebral arterial stenosis seems low. However, residual stenosis, comorbidity with underlying diseases and poor compliance with medical administrations were considered as risk factors for recurrence of stroke.
To evaluate the safety and efficacy of LVIS stent-assisted embolization of acutely ruptured intra-cranial wide-necked aneurysms.
Forty-eight patients with acutely ruptured intracranial wide-necked aneurysms treated with LVIS stent-assisted embolization at Department of Neurosurgery, Heze Municipal Hospital from January 2014 to June 2016 were enrolled into this study. The clinical data, procedure-related complications, embolization rate of aneurysms, imaging follow-up results and clinical outcomes of the 48 patients were analyzed retrospectively.
The stents of 48 patients were released completely (100%). Raymond grade I embolization was achieved in 25 cases (52.1%), Raymond grade Ⅱ embolization in 18 cases (37.5%), and Raymond grade Ⅲ embolization in 5 cases (10.4%). Four patients had in-stent thrombosis including 2 cases occurring in the process of embolization and 2 occurring within 24 hours post embolization.Following treatment with tirofiban hydrochloride, the thrombosis disappeared and permanent hemiplegia remained in 1 patient. Incomplete stent expansion was seen in 1 patient and improved after dilatation by balloon. Two aneurysms ruptured in the operation and were secured by subsequent coiling. Among the 39 (81.2%) patients who underwent angiographic follow-up lasting 6-11 months (mean: 7.8±3.6 months), 35 (89.7%) patients gained complete occlusion, 3(7.7%), 3 aneurysms were stable and 1 (2.6%) reported recurrence of aneurysm. No rebleeding occurred in all aneurysms at the 6-month follow-up. Thirty-eight patients had good outcome (modified Rankin scale, mRS: 0-2), 8 reported poor effect (mRS: 3-5), and the rate of good outcome was 82.6%.
Application of LVIS stent-assisted embolization of acutely ruptured intracranial wide-necked aneurysms is suggested to be safe and feasible. Further research is needed to determine the long-term stability of stents after embolization.
To investigate the safety and efficacy of the application of lateral supraorbital (LSO) approach for microsurgical resection of olfactory groove meningiomas.
Between January 2013 and December 2016, 20 patients with olfactory groove meningiomas underwent surgery through LSO approach at Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine. Their clinical data, surgical treatment and outcomes were analyzed retrospectively. Neuroradiological findings, improvement of symptoms and some relevant evaluation scales were used to assess the efficacy and safety of LSO for resection of olfactory groove meningiomas.
Six patients had Simpson grade Ⅰ resection, 12 had Simpson grade Ⅱ grade resection and 2 had Simpson grade Ⅳ resection. The mean operation time was 204.8±77.4 min and the mean intraoperative blood loss was 192.5±109.2 ml. Four patients developed fever post operation, 1 had psychiatric symptoms, 1 had disturbance of consciousness, 1 had cerebral edema, and 1 developed seizure. No incision infection or cerebrospinal fluid rhinorrhea occurred. Post surgery, 2 out of 8 patients with preoperative impairment of olfactory function obtained symptomatic improvement. Among the 4 patients with vision impairment, 2 achieved improvement, 1 remained the same and 1 reported aggravation. During the follow-up of 19 patients lasting 3-40 months with an average of 16.4±9.7 months, favorable outcomes were reported in 16 cases, severe disability in 1 and tumor recurrence in 2. There was no death.
Microsurgery through LSO approach demonstrates advantages in resection of olfactory groove meningiomas including shorter operative duration, less invasiveness, and low morbidity and mortality, which is thus worthy of recommendation.
To investigate the possible pathogenesis of infantile spasm (IS) by analyzing the changes of resting-state fMRI (rs-fMRI) regional homogeneity (ReHo) in preoperative IS patients.
From January 2014 to December 2015, a total of 11 patients of intractable IS were admitted to Neurosurgery Department of Shenzhen Children Hospital for presurgical evaluation. Besides the patients, 35 age- and sex-matched healthy subjects were enrolled into this retrospective study. In order to identify the pattern of regional synchronization in IS patients, all the children in this study received rs-fMRI scan and were analyzed by the software DPARSFV1.0.
Compared with healthy subjects, in the IS group, decreased ReHo were shown in bilateral precunei, bilateral middle occipital gyri, right middle temporal gyrus, right inferior parietal lobule, right cryptocalcarine gyrus, left central posterior gyrus, left precentral gyrus and left angular gyrus while increased ReHo were demonstrated in the right anterior cingulate gyrus, bilateral brain stems, bilateral hippocampi, bilateral thalami, right caudate nucleus, left cerebellum, left pars opercularis, bilateral insula lobes, right accessory motor area and right olfactory region(both P<0.05). Correlation analysis showed that lower ReHo values of the right precuneus (r value: -0.973) and left superior parietal lobule (r value: -0.978) were associated with longer duration of epilepsy (both P<0.01).
Our results suggest that IS may cause significant damage to children's brain areas related to motion, execution and cognition.
To observe the range of exposure, indications and feasibility of retromastoid keyhole approach through drilled petrous ridge to the middle fossa.
The eight adult cadareric heads in this study were provided by the anatomy laboratory of the second affiliated hospital of Soochow Univer sity. Simulated surgeries via retromastoid keyhole approach with assistance of neuroendoscope were performed on 8 adult cadaveric heads (16 sides) fixed by formalin and the maximal ranges of exposure were observed. The neuroendoscope was used to observe anatomical structures in the middle fossa and identify the limits of the Parkinson's triangle. The distances from the posterior border of junction of lateral sinus and sigmoid sinus to middle fossa and the length of all sides of Parkinson's triangle were measured.
Identified under endoscope, the exposure range of this approach included cerebellopontine angel (CPA), ventrolateral brainstem, tentorial incisure, petroclival region and lateral wall of cavernous sinus. The exposed anatomical structures in the middle fossa included trigeminal ganglion, cavernous segment of trochlear and abducent nerve, petroclinoid segment of oculomotor nerve, posterior curve segment of internal carotid artery (ICA) in cavernous sinus, communicating segment of ICA and posterior communicating artery (PCoA). Measurement results suggested that the distances from the midpoint of posterior border of sigmoid sinus to suprameatal tubercle, trigeminal ganglion, posterior curve segment of ICA were 34.4±2.1 mm, 54.5±2.9 mm and 65.2±3.1 mm, respectively. The lengths of all sides of Parkinson’s triangle were 19.0±2.9 mm, 16.2±2.0 mm and 8.0±2.3 mm, respectively.
The retromastoid keyhole approach via drilled petrous ridge leads to feasible exposure of the middle fossa under neuroendoscope, which could be applied in operations of most lesions in the posterior fossa such as tumors and aneurysms as well as those mainly in the posterior fossa and minorly affecting the middle fossa.
To explore the appropriate timing of tracheostomy in patients with severe cerebrovascular disorders requiring mechanical ventilation.
A retrospective analysis was conducted regarding patients with severe cerebrovascular disorders undergoing tracheostomy at the Neurosurgical Care Units (NICU) of General Hospital, Tianjin Institute of Neurology, Tianjin Medical University and Tianjin Haihe Hospital from January 2009 to December 2014. Early tracheostomy (ET) was defined as that performed on days 1-4 and late tracheostomy (LT) on days 7-14 post admission to NICU. ET was performed in 80 patients and LT in 73 patients. The primary outcome was length of stay at the NICU and secondary outcomes were diverse aspects of the NICU course.
The ICU length of stay, total length of hospital stay, duration of sedation, days of mechanical ventilation and duration of antibiotic use for patients undergoing ET were significantly shorter in comparison with those in the LT group (all P<0.01). Patients receiving ET had a significantly lower incidence of pneumonia in comparison with those in the LT group (P<0.01). Between the ET and LT groups, no significant difference was observed with regard to ICU mortality, hospital mortality or average score at discharge according to the modified Rankin scale(allP<0.05). The follow-up time is 6 months. Decannulation occurred earlier (58.2±27.2vs. 69.0±26.8 d, P=0.03) in the ET group.
Compared with LT, ET could be advantageous in patients with severe cerebrovascular disorders and relatively long period of mechanic ventilation in terms of shorter length of ICU stay, length of hospital stay, duration of sedation, days of mechanical ventilation and duration of antibiotic use. ET may reduce the incidence of pneumonia but does not seem to be associated with the improvement in mortality or neurologic outcome.
Infant spastic hemiplegia is often accompanied by drug-refractory epilepsy, and imaging usually shows extensive atrophy and softening of one cerebral hemisphere[
Massive cerebral infarction usually refers to a complete stroke of the main internal carotid artery, the main middle cerebral artery, or the cortical branch. Cerebral infarction accounts for 60% ~80% of stroke in China, which is an important cause of disability and death[
To explore the risk and significance of prophylactic surgery in the treatment of asymptomatic pediatric spinal cord lipomas.
We collected and reviewed studies of asymptomatic spinal cord lipomas in children from databases including PubMed, Embase, Scopus, Web of Science and Cochrane databases. RevMan5.3 and R software were used to conduct comparison between cases undergoing prophylactic surgery and those who were followed up without operations.
Five non-randomized controlled studies were reviewed and reported a total of 403 patients followed up for 4.4-10.0 years, among whom 124 patients received merely follow-up including 32 (25.8%) cases demonstrating neurological deterioration. The other 279 patients received prophylactic surgical treatment and 30 (10.8%) reported neurological dysfunction. The difference was statistically significant (P=0.05). At the same time, 9 literatures of merely surgery (278 cases) and 1 report (56 cases) of natural history were combined. The rate of neurological dysfunction was 10.0% post operation, which was significantly different from 28.6% (16/56) in the group with only follow-up based on the random effect model (P<0.01).
For asymptomatic spinal cord lipomas in children, limited literatures have suggested that prophylactic surgery might be beneficial to prevention of neurological deterioration, which needs evidences with large sample sizes in future research.
Meningioma mainly originates from cap cells of arachnoid, accounting for about 15% ~20% of primary intracranial tumors. It is one of the common intracranial tumors, but meningiomas outside the central nervous system are rare. Due to the lack of characteristic symptoms and signs, it is prone to clinical misdiagnosis. A patient with extracranial temporal fossa meningioma was admitted to the Department of Neurosurgery, Brain Hospital affiliated to Nanjing Medical University in April 2016. Combined with the relevant literature in recent years, it is summarized and reported as follows.
Subarachnoid hemorrhage caused by intracranial tumors is rare, and hemorrhage from brain tumors accounts for 1% ~11% of cerebral hemorrhage[
The local anatomy involved in neurosurgery is complex, and the amount of data information provided by single modal imaging is small, which cannot meet the clinical needs. In recent years, medical 3D image fusion technology has developed rapidly, and combined with neuronavigation and intraoperative imaging, it has been gradually applied to many neurosurgical fields such as cerebrovascular disease, brain tumor, epilepsy surgery, spinal vascular malformation, trigeminal neuralgia and hemifacial spasm[
In the central nervous system, glial cells account for about 90% of the total number of cells, and astrocytes are its main component. For a long time, it has been believed that the main functions of the central nervous system are performed by neurons, while astrocytes only play the functions of supporting, nourishing and metabolizing neurons. In recent years, it has been found that astrocytes also play an important role in maintaining normal brain function[
According to the 2012 China Cancer Registry Annual Report, intracranial and central nervous system malignant tumors accounted for 2.25% of systemic malignant tumors, and the standardized incidence rate of China's population was 4.11/100,000. Among them, the incidence of high-grade gliomas (HGG) is 5~8/1 million[
Gliomas are the most common intracranial tumors, accounting for about 80% of intracranial malignant brain tumors[
In recent years, more and more studies have been made at home and abroad on the etiology, pathogenesis, treatment and complications of hemifacial spasm (HFS), and great progress has been made. However, there are few studies on the recovery time limit and countermeasures of facial paralysis after HFS operation, and the time boundary for clinical intervention of postoperative facial paralysis (including facial paralysis caused by facial nerve injury and facial paralysis with delayed appearance after operation) is still unclear. This article searched eight databases, including PubMed, MedLine, Web of Science, Embase, CNKI, Wanfang, VIP and SinoMed, to collect the current research on facial paralysis after HFS surgery at home and abroad, and reviewed the research progress of recovery time and countermeasures of facial paralysis after HFS microvascular decompression (MVD).
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