Perioperative hydrocortisone for modulating stress and inflammation after microvascular decompression for hemifacial spasm: a single-center, randomized, assessor-blinded, controlled trial protocol

Background Microvascular decompression (MVD) for hemifacial spasm triggers substantial perioperative stress and inflammatory responses that may contribute to early postoperative symptoms and potentially influence long-term surgical outcomes. Perioperative corticosteroids can modulate these responses, but their efficacy and safety in this specific neurosurgical population remain inadequately characterized. This trial aims to evaluate whether short-course perioperative hydrocortisone reduces early postoperative symptom burden and to explore its effects on biomarker dynamics and long-term efficacy. Methods This single-center, randomized, assessor-blinded, controlled trial will enroll 100 patients aged 18–70 years undergoing elective MVD for primary hemifacial spasm. Participants will be allocated 1:1 to receive either intravenous hydrocortisone (100 mg at induction, then days 1–2) or matching placebo. Primary outcomes are mean postoperative headache intensity (visual analogue scale, days 1–3) and 72-h cumulative rescue opioid consumption (oral morphine milligram equivalents). Secondary outcomes include recovery parameters, postoperative symptoms, and inflammatory biomarkers (interleukin-6, C-reactive protein, S100B), with serum cortisol reported only as a descriptive drug exposure variable. Long-term hemifacial spasm control and quality of life at 6 months will be explored. Safety monitoring includes infection, hyperglycemia, and psychiatric symptoms through 30 days. Intention-to-treat analysis will use Bonferroni-adjusted α = 0.025 for primary outcomes. Ethics and dissemination The protocol has been approved by the Medical Ethics Committee of the Second People’s Hospital of Liaocheng (Approval Number: [2025] Ethical Review No. (090), date of approval: 31 December 2025). The trial was prospectively registered in the Chinese Clinical Trial Registry (ChiCTR2600117513) on 26 January 2026, and recruitment of the first participant has not yet commenced. All participants will provide written informed consent. Results will be disseminated through peer-reviewed publications and conference presentations regardless of findings. Critical trial registration https://www.chictr.org.cn/ , ChiCTR2600117513.