微血管减压术治疗老年三叉神经痛的有效性和安全性分析

Efficacy and safety of microvascular decompression for the treatment of elderly patients with trigeminal neuralgia

目的探讨微血管减压术治疗老年三叉神经痛的有效性和安全性。方法共286例原发性三叉神经痛患者[≥70岁50例(老龄组),<70岁236例(低龄组)]均采用患侧枕下经乙状窦后入路行微血管减压术,记录术后并发症,包括术侧面部麻木感、术侧听力下降、脑脊液漏、手术切口愈合欠佳、颅内感染、脑积水;采用Barrow神经病学研究所(BNI)三叉神经痛分级评价疼痛缓解;记录随访期间复发率。结果 286例患者中36例(12.59%)出现术后并发症,低龄组29例(12.29%),老龄组7例(14%),组间差异无统计学意义(χ~2=0.110,P=0.740),为术侧面部轻度麻木感18例(6.29%)、术侧听力下降13例(4.55%)、脑脊液漏1例(0.35%)、手术切口愈合欠佳1例(0.35%)、颅内感染2例(0.70%)和脑积水1例(0.35%)。随访29.43个月,随访的216例低龄组患者中170例(78.70%)疼痛完全缓解(BNI分级Ⅰ级),10例(4.63%)疼痛部分缓解(BNI分级Ⅱ~Ⅲ级),14例(6.48%)疼痛无缓解(BNI分级Ⅳ~Ⅴ级),22例(10.19%)复发;随访的44例老龄组患者中35例(79.55%)疼痛完全缓解(BNI分级Ⅰ级),2例(4.55%)疼痛部分缓解(BNI分级Ⅱ~Ⅲ级),1例(2.27%)疼痛无缓解(BNI分级Ⅳ~Ⅴ级),6例(13.64%)复发,组间预后差异无统计学意义(χ~2=1.530,P=0.675)。Kaplan-Meier曲线显示,随着随访时间的延长,两组患者术后疼痛完全缓解率均逐渐下降。结论单纯微血管减压术治疗老年三叉神经痛安全、有效,未出现死亡或神经功能障碍等严重并发症。

Objective To analyze the efficacy and safety of microvascular decompression（MVD）for the treatment of elderly patients with trigeminal neuralgia（TN）.Methods A total of 286 primary TN patients[50 cases of age≥70 years（older group）and 236 cases of age〈70 years（younger group）]underwent MVD via suboccipital sigmoid approach.Postoperative complications were recorded,including facial numbness of operation side,hearing loss of operation side,cerebrospinal fluid（CSF）leakage,poor wound healing,intracranial infection and hydrocephalus.Barrow Neurological Institute（BNI）grade was used to evaluate the relief of TN before and after surgery and during the follow-up.The recurrence rate during follow-up period was recorded.ResultsOf all cases,36（12.59%）presented with postoperative complications,including 18 cases（6.29%）of facial numbness of operation side,13 cases（4.55%）of hearing loss of operation side,one case（0.35%）of CSF leakage,one case（0.35%）of poor wound healing,2 cases（0.70%）of intracranial infection and one case（0.35%）of hydrocephalus.In those 36 cases,29 cases（12.29%）were in younger group and 7 cases（14%）were in older group,and there was no significant difference between 2 groups（0.110,P=0.740）.The mean follow-up period was 29.43 months.During the follow-up,170 cases（78.70%）had complete pain relief（BNI gradeⅠ）,10 cases（4.63%）had partial pain relief（BNI gradeⅡ-Ⅲ）,14 cases（6.48%）had no pain relief（BNI gradeⅣ-Ⅴ）,and 22（10.19%）recurred TN in 216 cases of the younger group;35 cases（79.55%）had complete pain relief（BNI gradeⅠ）,2 cases（4.55%）had partial pain relief（BNI gradeⅡ-Ⅲ）,one case（2.27%）had no pain relief（BNI gradeⅣ-Ⅴ）,and 6 cases（13.64%）recurred TN in 44 cases of the older group.There was no significant difference on prognosis between 2 groups（1.530,P=0.675）.Kaplan-Meier curve showed the rate of complete pain relief was decreased with time.ConclusionsPure MVD for treating elderly patients with TN is safe and effective,without postoperative death or severe complications.