Abstract: Objective To evaluate the application value of preoperative three-dimensional reconstruction combined with neuroendoscopic assistance in microvascular decompression of posterior sigmoid sinus nerves and analyze the risk factors for postoperative complications. Methods A retrospective analysis was conducted on 244 patients with hemifacial spasm admitted to our hospital from January 2021 to December 2023.They were divided into a control group (126 cases) who received conventional microvascular decompression (MVD) and a control group who received three-dimensional reconstruction combined with nerve surgery.Observation group of endoscopically assisted MVD (118 cases).Study indicators included perioperative data,Cohen spasticity score,inflammatory markers (IL-6,TNF-α),quality of life scores,clinical efficacy and complications.Univariable and multivariable logistic regression analysis were used to explore the related risk factors for postoperative complications. Results The operation time,intraoperative blood loss and hospitalization time of the patients in the observation group were significantly shorter than those in the control group.The 6-month follow-up after surgery showed that the observation group was better than the control group in terms of improvement in Cohen's spasticity score,reduction in IL-6 and TNF-α inflammation levels,and improvement in quality of life score (P＜0.05).In terms of efficacy,the overall effective rate of the observation group was 94.92%,which was significantly higher than the 82.54% of the control group (Z=4.461,P=0.000;χ²=9.187,P=0.002).The incidence rate of complications in the observation group was 8.47%,which was significantly lower than the 17.46% in the control group (χ²=4.318,P=0.038).Logistic regression analysis showed that treatment method (OR=0.605,95%CI:0.4980.734) was a negative predictor of complications,while arteriosclerosis (OR=2.158,95%CI:1.7602.645) and hypertension status were responsible.(OR=1.449,95%CI:1.222~1.719) is a positive predictor. Conclusion Three-dimensional reconstruction combined with neuroendoscopic-assisted microvascular decompression can effectively optimize the perioperative indicators of patients with hemifacial spasm,significantly improve clinical symptoms,reduce inflammatory reactions,improve quality of life,and is highly safe.Hypertension,responsible arteriosclerosis and surgical method are independent predictors of postoperative complications.

Key words: Neuroendoscopy, Three-dimensional reconstruction, Microvascular decompression, Complications, Risk factor analysis, Hemifacial spasm

摘要： 目的 评估术前三维重建联合神经内镜辅助在乙状窦后入路面神经微血管减压术中的应用价值,并分析术后并发症的危险因素。方法 回顾性分析2021年1月至2023年12月期间我院收治的244例面肌痉挛患者,分为接受常规微血管减压术(MVD)的对照组(126例)和接受三维重建联合神经内镜辅助MVD的观察组(118例)。研究指标包括围术期数据、Cohen痉挛评分、炎症标志物(IL-6、TNF-α)、生活质量评分、临床疗效及并发症。采用单变量及多变量Logistic回归分析,探讨术后并发症的相关危险因素。结果 观察组患者的手术时间、术中出血量及住院时间均显著短于对照组。术后6个月随访显示,观察组在Cohen痉挛评分改善、IL-6及TNF-α炎症水平降低、生活质量评分提升方面均优于对照组(P<0.05)。疗效方面,观察组整体有效率为94.92%,显著高于对照组的82.54%(Z=4.461,P=0.000;χ²=9.187,P=0.002)。并发症发生率观察组为8.47%,显著低于对照组的17.46%(χ²=4.318,P=0.038)。Logistic回归分析表明,治疗方式(OR=0.605,95%CI:0.4980.734)为并发症的负向预测因素,而责任动脉硬化(OR=2.158,95%CI:1.7602.645)及高血压状态(OR=1.449,95%CI:1.222~1.719)为正向预测因素。结论 三维重建联合神经内镜辅助的微血管减压术可有效优化面肌痉挛患者的围术期指标,显著改善临床症状、降低炎症反应、提升生活质量,并具有较高的安全性。高血压、责任动脉硬化及手术方式是术后并发症的独立预测因素。

关键词: 神经内镜, 三维重建, 微血管减压术, 面肌痉挛, 并发症, 危险因素分析