Sindou Marc, Leston José, Decullier Evelyne, Chapuis François
Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, University of Lyon, France.
J Neurosurg. 2007 Dec;107(6):1144-53. doi: 10.3171/JNS-07/12/1144.
The purpose of this study was to evaluate the long-term efficacy of microvascular decompression (MVD) and to identify the factors affecting outcome in patients treated for primary trigeminal neuralgia (TN). Only the cases with a clear-cut neurovascular conflict (vascular contact and/or compression of the root entry zone of the trigeminal nerve) found at surgery and treated with "pure" MVD (decompression of the root without any additional lesioning or cutting of the adjacent rootlets) were retained.
The study included 362 patients who were followed up over a period of 1 to 18 years (median follow-up 7.2 years). A Kaplan-Meier survival analysis was generated at 1 and 15 years of follow-up for all of the considered factors. According to Kaplan-Meier analysis, the success rate (defined as pain-free patients without any medication) was 91% at 1 year and estimated to be 73.38% after 15 years of follow-up.
None of the following patient-related factors played any significant role in prognosis: sex, patient age at surgery, history of systemic hypertension, duration of neuralgia before surgery, or history of failed trigeminal surgery. Patients with atypical neuralgia (a baseline of permanent pain) had the same outcome as those with a typical (purely spasmodic) presentation. In addition, the side and topography of the trigeminal nerve did not play a role, whereas involvement of all three divisions of the nerve had a negative effect on outcome. Concerning anatomical factors, neither the type of the compressive vessel nor its location along or around the root was found to be significant. However, the severity of compression was important-the more severe the degree of compression, the better the outcome (p = 0.002). The authors also found that presence of focal arachnoiditis had a negative influence on outcome (p = 0.002).
Pure MVD can offer patients affected by a primary TN a 73.38% probability of long-term (15 years) cure of neuralgia. The presence of a clear-cut and marked vascular compression at surgery (and possibly-although not yet reliably--on preoperative magnetic resonance imaging) is the guarantee of a higher than 90% success rate.
本研究旨在评估微血管减压术（MVD）的长期疗效，并确定影响原发性三叉神经痛（TN）患者治疗效果的因素。仅纳入手术中发现明确的神经血管冲突（血管接触和/或三叉神经根入区受压）且接受“单纯”MVD治疗（神经根减压，不附加任何对相邻小根的损伤或切断）的病例。
该研究纳入362例患者，随访时间为1至18年（中位随访时间7.2年）。对所有考虑的因素在随访1年和15年时进行Kaplan-Meier生存分析。根据Kaplan-Meier分析，成功率（定义为无需任何药物治疗的无痛患者）在1年时为91%，随访15年后估计为73.38%。
以下患者相关因素在预后中均未发挥显著作用：性别、手术时患者年龄、系统性高血压病史、手术前神经痛持续时间或三叉神经手术失败史。非典型神经痛（持续性疼痛基线）患者与典型（单纯痉挛性）表现患者的治疗效果相同。此外，三叉神经的侧别和部位不起作用，而神经的所有三个分支均受累对治疗效果有负面影响。关于解剖学因素，受压血管的类型及其沿神经根或在神经根周围的位置均无显著意义。然而，压迫的严重程度很重要——压迫程度越严重，治疗效果越好（p = 0.002）。作者还发现局灶性蛛网膜炎的存在对治疗效果有负面影响（p = 0.002）。
单纯MVD可为原发性TN患者提供73.38%的长期（15年）神经痛治愈概率。手术中存在明确且明显的血管压迫（术前磁共振成像可能——尽管尚未可靠——显示）是成功率高于90%的保证。
