Effect of modified method of skull closing in microvascular decompression

Abstract

Objective To investigate the effect of modified method of skull closing in microvascular decompression (MVD) on the incidence of postoperative cerebrospinal fluid (CSF) leakage. Methods We retrospectively analyzed the clinical data of 257 patients who underwent MVD from August 2013 to October 2016 at Department of Neurosurgery, the Affiliated Hospital of Southwest Medical University. Among them, traditional method of skull closing was used in 151 cases before July 2015 and 106 cases received modified method of skull closing after July 2015. The modifications involved aspects including suturing of dual matter, skull reconstruction and suturing of skin. To study the effect, the incidences of CSF leakage and other complications were compared between the traditional and modified groups. Results The surgical effective rates for hemifacial spasm in traditional and modified groups were 91.3%(73/80) and 90.2%(55/61), respectively, and the difference was not statistically significant (P=0.825). The effective rates for trigeminal neuralgia in traditional and modified groups were 85.9%(61/71) and 84.4%(38/45), respectively, and the difference was not statistically significant (P=0.827). The incidences of CSF leakage in traditional and modified groups were 6.6%(10/151) and 0(0/106), respectively, and the difference was statistically significant (P=0.018). The incidence of other complications in traditional group was 10.6%(16/151), which included 6 cases of facial numbness, 2 cases of hearing loss, 2 cases of tinnitus, 5 cases of facial paralysis and 1 cases of intracranial infection. The incidence of other complications in modified group was 9.4%, which included 6 cases of facial numbness, 2 cases of hearing loss and 2 cases of facial paralysis. There was no significant difference in incidence of other complications between two groups (P=0.761). All patients were followed up for 2-23 months, and the median follow-up time was 11 months. Conclusion The modified method of skull closing in MVD could help reduce the incidence of postoperative CSF leakage and may be worthy of further promotion. Key words: Microvascular decompression; Hemifacial spasm; Trigeminal neuralgia; Cerebrospinal fluid leakage