单纯微血管减压术治疗三叉神经痛的有效性和安全性分析

Safety and efficacy of pure microvascular decompression for trigeminal neuralgia

目的探讨微血管减压术治疗原发性三叉神经痛的有效性和安全性,并筛查其复发相关危险因素。方法共286例单纯行微血管减压术的原发性三叉神经痛患者,分别于术前、术后和随访期间采用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;记录随访期间复发情况。单因素和多因素前进法Logistic回归分析筛查三叉神经痛复发相关危险因素。结果 286例患者中术后18例(6.29%)出现术侧面部轻度麻木感,13例(4.55%)术侧听力下降,1例(0.35%)脑脊液漏,1例(0.35%)手术切口愈合欠佳,2例(0.70%)颅内感染,1例(0.35%)脑积水。随访期间26例(9.09%)失访,13例(4.55%)术后疼痛无缓解,13例(4.55%)术后疼痛部分缓解,234例(81.82%)术后疼痛完全缓解。234例术后疼痛完全缓解患者平均随访31.29个月,1例(0.35%)死于心脏病,28例(9.79%)复发。Kaplan-Meier曲线显示,术后疼痛完全缓解率随着随访时间的延长而逐渐下降,其中术后1年复发率5.4%、术后3年15.2%、术后5年21.2%。单因素和多因素前进法Logistic回归分析显示,术前BNI分级Ⅴ级是三叉神经痛复发的独立危险因素(OR=2.385,95%CI:1.063～5.353;P=0.035)。结论微血管减压术治疗三叉神经痛安全、有效,无死亡或神经功能障碍等严重并发症。

Objective To analyze the efficacy and safety of pure microvascular decompression（MVD） for trigeminal neuralgia（TN）, and to screen related risk factors for TN recurrence. Methods A total of 286 primary TN patients underwent pure MVD. Barrow Neurological Institute（BNI） grade was used to evaluate the relief of TN before and after surgery and during the follow-up. 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. The recurrence during follow-up was also recorded. Univariate and multivariate forward Logistic regression analysis were used to screen related risk factors of recurrent TN. Results Of all patients, 18 cases（6.29%） had slight facial numbness of operation side after surgery, 13 cases（4.55%） had hearing loss of operation side after operation. One（0.35%） had CSF leakage, and was cured after lumbar cistern drainage. One（0.35%） had no wound healing, and was cured after bone wax and repairing titanium mesh were removed in the reoperation. Two cases（0.70%） had intraranial infection and were cured by antibiotic therapy. One（0.35%） had hydrocephalus and was cured after external ventricular drainage. Of 286 patients, 26 cases（9.09%） were lost during the follow-up, 13 cases（4.55%） had no pain relief after surgery, 13 cases（4.55%）had partial pain relief after surgery and 234 cases（81.82%） had complete pain relief after surgery. The follow-up period of 234 cases was a mean of 31.29 months. During follow-up, one case（0.35%） died of heart disease, and 28 cases（9.79%） had pain recurrence. Kaplan-Meier curve showed the rate of complete pain relief was decreased with time, the recurrence rate was 5.4% one year after surgery, 15.2% 3 years after surgery, and 21.2% 5 years after surgery. Univariate and multivariate forward Logistic regression analysis showed preoperative BNI grade V was independent risk factor for recurrence of TN（OR = 2.385,95% CI： 1.063-5.353; P = 0.035）. Conclusions Pure MVD for treating TN is safe and effective, without postoperative death or severe complications.