Safety and efficacy of endoscope-assisted versus microscopic microvascular decompression surgery for hemifacial spasm: a prospective cohort study.

Abstract

Microscopic microvascular decompression (M-MVD) is a classical treatment for relieving long-term hemifacial spasms (HFS). An endoscopy technique has recently been introduced to improve M-MVD; however, this application remains debatable. This study compared the safety and effectiveness of endoscope-assisted microvascular decompression (EA-MVD) and M-MVD for HFS. From February 2021 to September 2022, we enrolled 49 patients with HFS assigned to the EA-MVD (n = 26) and M-MVD (n = 23) groups. The patients were assessed with Park YS grades, operative time, hospital days, and complications. Evaluations were performed in the early postoperative period, at one month, 3months, 6months, and at least 12months. Twenty-three (23/26, 88.5%) patients in the EA-MVD group and 20 (20/23, 87.0%) patients in the M-MVD group achieved spasm-free relief, ranging over "excellent" and "good" Park YS grades. The operative time in the EA-MVD and M-MVD groups were 143 ± 28min and 145 ± 22min (p = 0.002). The duration of hospital stay was 6.8 ± 0.8days and 7.2 ± 1.3days in the EA-MVD and M-MVD groups (p = 0.002), respectively. All surgeries for HFS were successful, with no death, stroke, hearing loss, facial numbness, or other extreme complications. In conclusion, EA-MVD, compared with M-MVD, demonstrated equally effective outcomes with decreased operative time and hospital stays, providing bright intraoperative illumination and flexible surgical vision.