Improving recovery after microvascular decompression surgery for hemifacial spasm: experience from 530 cases with enhanced recovery after surgery (ERAS) protocol

Wang, Dongliang; Fang, Jixia; Liu, Jiayu; Hao, Qingpei; Ding, Hu; Liu, Bo; Liu, Zhi; Song, Haidong; Ouyang, Jia; Liu, Ruen

doi:10.1080/02688697.2021.1888876

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…ERAS protocols for craniotomy have recently been developed [ 16 , 17 , 27 ], and a scalp block is one of the main anesthetic elements. As Wang et al emphasize [ 20 ], effective pain control using a scalp nerve block after MVD is important not only for analgesia, but also to improve the quality of recovery. Although the induction time of the block group was 5.7 min longer than in the control group, it did not lengthen the overall surgery time or anesthetic time.…”

Section: Discussionmentioning

confidence: 99%

“…Scalp nerve block has been introduced and implemented in various neurosurgeries to stabilize surgical procedures, manage postoperative pain, and reduce opioid consumption [ 13 , 14 , 15 ]. The ERAS protocol for elective craniotomy recommends the use of a scalp block in addition to NSAID [ 16 , 17 , 18 , 19 , 20 ], but evidence on this topic is lacking. Therefore, in this study, we evaluated the efficacy of a regional scalp nerve block in HFS patients undergoing MVD via the lateral suboccipital approach, a region associated with severe postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy of Scalp Nerve Block in Postoperative Pain Management after Microvascular Decompression: A Randomized Clinical Trial

Lee,

Kwon

et al. 2023

JCM

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The scalp nerve block, created by injecting local anesthetics around the scalp nerves, is reported to effectively reduce pain after surgery. In this study, we evaluated the efficacy of scalp nerve block in patients with hemifacial spasm (HFS) undergoing microvascular decompression (MVD). Seventy-four patients who underwent MVD for HFS were enrolled. The block group received scalp nerve block with 0.5% ropivacaine before surgery. The primary outcome was cumulative dose of rescue analgesics 24 h postoperatively. The secondary outcomes were included pain scores, postoperative antiemetic consumption, and Quality of Recovery-15 scale. The cumulative dose of rescue analgesics at 24 h postoperatively was not significantly different between the two groups (4.80 ± 3.64 mg vs. 5.92 ± 3.95 mg, p = 0.633). However, the pain score was significantly reduced in the block group at 6, 12, and 24 h postoperatively. Postoperative antiemetic consumption was lower in the block group than the control group at 12 h. There were no significant differences between the two groups for other secondary outcomes. In MVD for HFS, a preoperative scalp nerve block might reduce postoperative pain in the early postoperative period, but a larger study using a multimodal approach is needed to confirm the efficacy of a scalp block.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Efficacy of Scalp Nerve Block in Postoperative Pain Management after Microvascular Decompression: A Randomized Clinical Trial

Lee,

Kwon

et al. 2023

JCM

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“…However, as a result of evidence from other specialties, multiple neurosurgical centers became interested in ERAS philosophy to guide patients' perioperative management. They progressively introduced local protocols for the treatment of different neurosurgical pathologies, 22,30,41 such as oncological pathologies, 24,27,42 intracranial aneurysm treatment, 25 microvascular decompression, 43 and pituitary pathologies. 23,26,28 Implementing a multidisciplinary ERAS protocol for the management of PitNET is feasible and may bring some clear clinical, organizational, and financial advantages.…”

Section: Discussionmentioning

confidence: 99%

The Enhanced Recovery After Surgery protocol for the perioperative management of pituitary neuroendocrine tumors/pituitary adenomas

Cossu,

Belouaer,

Kloeckner

et al. 2023

Neurosurgical Focus

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OBJECTIVE Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway that has radically modified the management of patients in multiple surgical specialties. Until now, no ERAS Society guidelines have been formulated for the management of cranial pathologies. During the process of ERAS certification for their neurosurgical department, the authors formulated an ERAS protocol for the perioperative care of patients with pituitary neuroendocrine tumors (PitNET), along with a compliance checklist to monitor the adherence to it and its feasibility. The authors describe the protocol and checklist and report the results, including a cost-minimization analysis, with the application of the ERAS philosophy. METHODS The steps that led to the development of this ERAS protocol, including items concerning the preoperative, intraoperative, and postoperative period, are detailed. The authors report their preliminary results through the comparison of the care practice of a historical cohort with a consecutive surgical cohort of patients with PitNET who underwent operation after the implementation of this ERAS protocol. A compliance checklist with key performance indicators was useful to monitor the adherence to the protocol and the changes in the perioperative management. RESULTS Following the introduction of this ERAS protocol, the authors significantly shortened the duration of the antibiotic therapy (p < 0.00001) and increased the use of mechanical (p < 0.00001) and pharmacological measures to prevent deep venous thrombosis (p = 0.002). The median length of hospital stay was significantly shorter for the ERAS group (p = 0.00014), and there was no increase in readmission rate or postoperative complications. The documentation and data tracking strongly improved in the ERAS cohort and the authors were more attentive in pain evaluation (p = 0.001), postoperative hormonal supplementation (p = 0.001) and early feeding and mobilization (p = 0.0008 and p < 0.00001, respectively). More patients were discharged on day 3 after surgery in the ERAS group (p < 0.00001). The compliance to the whole process increased from 64.2% to 89.5% (p = 0.016), and the compliance per patient was also found to have significantly increased (p < 0.00001). CONCLUSIONS The introduction of a standardized ERAS protocol for the perioperative management of patients with PitNET allowed the authors to improve the multidisciplinary management of these patients. With the application of simple cost-effective interventions and with the avoidance of unnecessary measures, gains were made in terms of early mobilization and feeding, thereby resulting in a shorter in-hospital stay.

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“…They are most common in women around the age of 50 and are mainly unilateral, which is consistent with the results of this study. Since Jannetta first systematically elaborated the theory of MVD in 1975, MVD has gradually been accepted by most neurosurgeons and it has become the main treatment for HFS ( 3 ). Although the cure rate of MVD for HFS is 70 to 98% ( 4 ), there is a 3.3 to 20% recurrence rate within 5 years after surgery ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…Neurovascular compression (NVC), proposed by Jannetta, which causes short circuits of nerve conduction due to microvascular compression, is currently recognized by most scholars as the pathogenesis of primary HFS ( 2 ). Microvascular decompression (MVD), based on Jannetta's peripheral nerve theory, has been proven to be effective ( 3 ). Although the cure rate of MVD for HFS is 70 to 98% ( 4 ), there is a 3.3 to 20% recurrence rate within five years after the operation ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Long-Term Retrospective Analysis of Re-do Microvascular Decompression in Patients With Hemifacial Spasm

Liu

et al. 2021

Front. Neurol.

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Objective: To explore the clinical characteristics of patients with persistent or recurrent hemifacial spasm (HFS) and the experience of microvascular decompression (MVD) in the treatment of such patients to accumulate additional clinical evidence for optimal treatment protocols.Methods: We retrospectively analyzed the clinical data, surgical methods and treatment efficacies of 176 patients with persistent or recurrent HFS from January 2009 to January 2018.Results: Missing compression zones was the main reason for symptom persistence (87.50%) or recurrence (71.50%) after MVD treatment of HFS. We divided the surgical area into three zones. Most persistent or recurrent cases had decompression only in the root exit zone (REZ) (Zone 1) but missed the ventrolateral pons-involved area (Zone 2) or the bulbopontine sulcus-involved area (Zone 3) in the first MVD. Too much use of Teflon (12.50%), arachnoid adhesions (5.60%) and Teflon granulomas (10.40%) can also cause a recurrence. The difference between preoperative and postoperative Cohen scores was statistically significant in persistent or recurrent HFS patients (p<0.05). The postoperative follow-up time ranged from 36 to 108 months (71.75 ± 22.77).Conclusions: MVD should be performed in the compression site, which is mostly located at the brainstem/facial REZ. Intraoperative exploration should be conducted in accordance with the abovementioned zones to effectively avoid missing offending vessels. Re-do MVD is effective in patients with persistent or recurrent HFS.

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Improving recovery after microvascular decompression surgery for hemifacial spasm: experience from 530 cases with enhanced recovery after surgery (ERAS) protocol

Cited by 4 publications

References 25 publications

The Efficacy of Scalp Nerve Block in Postoperative Pain Management after Microvascular Decompression: A Randomized Clinical Trial

The Efficacy of Scalp Nerve Block in Postoperative Pain Management after Microvascular Decompression: A Randomized Clinical Trial

The Enhanced Recovery After Surgery protocol for the perioperative management of pituitary neuroendocrine tumors/pituitary adenomas

Long-Term Retrospective Analysis of Re-do Microvascular Decompression in Patients With Hemifacial Spasm

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