Microscopic versus endoscopic microvascular decompression for the treatment of hemifacial spasm in China: A meta-analysis and systematic review.
MI-MVD, E-MVD
Microscopic microvascular decompression, Endoscopic microvascular decompression
MI-MVD vs E-MVD
Patient effective rate, Detection rate of offensive blood vessels, Total complication rate, Recurrence rate
Abstract
To date, microvascular decompression has become the standard surgical treatment for hemifacial spasm. Microscopic microvascular decompression (MI-MVD) and endoscopic microvascular decompression (E-MVD) are both popular with surgeons. The present study aims to investigate whether MI-MVD and E-MVD show better results as surgical treatments for hemifacial spasm in the Chinese population. Electronic retrieval of articles on PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure and Wanfang Database was performed to identify comparative studies on Chinese patients who underwent MI-MVD and E-MVD from January 2000 to December 2020. After data extraction and quality assessment of the included studies, a meta-analysis was performed using the Review Manager 5.4 software. The pooled incidence of patient effective rate, detection rate of offensive blood vessels, total complication rate, and recurrence rate were calculated. A total of 12 studies with 1122 patients (MI-MVD: 562, E-MVD: 560) were identified. The patient effective rate (MI-MVD: 89% vs E-MVD:97%, OR = 0.22, P < 0.00001) and detection rate of offensive blood vessels (MI-MVD:91% vs E-MVD:98%, OR = 0.17, P = 0.0002) showed patients with E-MVD were significantly higher than patients who underwent MI-MVD. However, the total complication rate (MI-MVD: 27% vs E-MVD:12%, OR = 2.92, P = 0.0002) and recurrence rates (MI-MVD:5.7% vs E-MVD:0.3%, OR = 8.8, P = 0.0005) showed patients with E-MVD were significantly lower than patients who underwent MI-MVD. In addition, the incidence of facial paralysis or weakness and hearing loss in E-MVD group was lower than that of in MI-MVD group, whereas no statistical difference was found between the two groups in terms of the incidence of cerebrospinal fluid leakage and intracranial infection. While the operation of MI-MVD is relatively simple and the learning curve is short, E-MVD is better than MI-MVD in terms of treatment effect, overall complications, and recurrence rate. Therefore, E-MVD can be used as an alternative to MI-MVD in the treatment of hemifacial spasm in the Chinese population.