面肌痉挛微血管减压术后听力损失的模式与预测因素：一项系统综述

文献信息

中文摘要

背景： 微血管减压术是治疗面肌痉挛安全有效的干预手段；然而，其与听力损害的潜在关联仍令人担忧。本研究旨在确定面肌痉挛患者微血管减压术后听力损失的患病率、模式及危险因素。方法：按照PRISMA指南，系统检索PubMed、Cochrane Library、ScienceDirect和Web of Science自建库至2025年4月的文献。纳入标准为接受微血管减压术治疗面肌痉挛、且具有术前和术后客观听力评估的成年患者。提取听力结局及潜在危险因素（如脑干听觉诱发电位、小脑操作和压迫血管）的数据。采用随机效应模型进行荟萃分析，并使用荟萃回归探索潜在调节因素。结果：共11项研究（N=4014）符合纳入标准。术后永久性听力损失的合并患病率为2.60%（95%置信区间[CI]：1.13%-5.87%），异质性较高（I2=87.4%）。亚组分析显示，前瞻性研究（n=4；5.29%）的患病率高于回顾性研究（n=7；1.97%），但差异无统计学意义。多数研究认为，脑干听觉诱发电位监测，尤其是V波潜伏期或波幅的变化，可一致地预测听力损害。过度的小脑牵拉（更大的深度、距离和持续时间）与听力损失风险增加显著相关。关于压迫血管类型的研究层面数据不足且在纳入研究中报告不一致，无法进行可靠的荟萃回归分析。结论：在接受微血管减压术治疗面肌痉挛的患者中，术后永久性听力损失估计发生率约为2.6%（范围：1.1%-5.9%）（95%置信区间[CI]：1.13%-5.87%），但由于研究间存在显著异质性（I2=87.4%），合并估计值仍不稳定，限制了该估计的精确性。该风险主要受术中操作小脑和脑干听觉诱发电位变化的影响。精细的手术技术和术中神经监测可降低该并发症的风险。

英文摘要

Microvascular is a safe and effective therapeutic intervention for hemifacial spasm; however, its potential association with hearing impairment remains a concern. This study aimed to determine the prevalence, patterns, and risk factors of hearing loss following microvascular decompression in patients with hemifacial spasm. In accordance with PRISMA guidelines, a systematic literature search was conducted across PubMed, Cochrane Library, ScienceDirect, and Web of Science from inception to April 2025. Eligible studies included adult patients undergoing microvascular decompression for hemifacial spasm with preoperative and postoperative objective hearing assessments. Data on hearing outcomes and potential risk factors (e.g., brainstem auditory evoked response, cerebellar manipulation, and compressing vessels) were extracted. Meta-analysis was performed using a random-effects model, and meta-regression was used to explore potential moderators. Eleven studies (N = 4,014) met the inclusion criteria. The pooled prevalence of permanent postoperative hearing loss was 2.60% (95% confidence interval [CI]: 1.13%-5.87%), with high heterogeneity (I2 = 87.4%). Subgroup analysis revealed a higher prevalence in prospective studies (n = 4; 5.29%) compared to retrospective studies (n = 7; 1.97%), although the difference was not statistically significant. Most studies concluded that brainstem auditory evoked response monitoring, particularly changes in wave V latency or amplitude, consistently predicted hearing impairment. Excessive cerebellar retraction (greater depth, distance, and duration) was significantly associated with an increased risk of hearing loss. Study-level data regarding the type of compressing vessel were insufficient and inconsistently reported across the included studies, precluding reliable meta-regression analysis. Permanent postoperative hearing loss was estimated to occur in approximately 2.6% (range: 1.1%-5.9%) (95% confidence interval [CI]: 1.13%-5.87%) of patients undergoing microvascular decompression for hemifacial spasm, although the pooled estimate remained unstable because of substantial between-study heterogeneity (I2 = 87.4%), limiting the precision of this estimate. The risk is primarily influenced by intraoperative cerebellar manipulation and brainstem auditory evoked response changes. Meticulous surgical technique and intraoperative neuromonitoring can reduce the risk of this complication.