Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
J Neurosurg. 2010 Sep;113(3):511-5. doi: 10.3171/2009.12.JNS09977.
Trigeminal neuralgia (TN) is a neuropathic pain syndrome that is often associated with neurovascular compression of the trigeminal nerve and may be effectively treated with microvascular decompression (MVD). The authors used high-resolution MR imaging with 3D reconstruction in patients with constant facial pain (Type 2 TN) to determine the presence/absence of neurovascular compression and thus a potential MVD benefit. They retrospectively contacted patients to evaluate outcome.
All patients who reported spontaneous onset of constant facial pain (Type 2 TN), which occurred at least 50% of the time, who had undergone high-resolution 3-T MR imaging with 3D reconstruction were retrospectively selected for this study. Clinical history, facial pain questionnaire data, physical examination findings, and results from 3-T 3D MR imaging reconstruction were recorded for all patients. Intraoperative findings and clinical pain outcome were recorded for all patients who underwent MVD.
Data obtained in 27 patients were assessed. On the basis of history and 3D MR imaging reconstruction findings, 13 patients were selected for MVD (Group A) and 14 underwent conservative treatment (Group B). Typical or suspected artery- or vein-induced neurovascular compression was predicted preoperatively in 100% of Group A patients and in 0% of Group B patients. At the time of MVD, definitive neurovascular compression was confirmed in 11 (84.6%) of 13 Group A patients. Following MVD, facial pain was completely relieved in 3 (23%), improved in 7 (53.8%), and no better in 3 (23%) of 13 Group A patients. A history of episodic (Type 1 TN) pain at any time was reported in 100 and 50% of Group A and Group B patients, respectively. A Type 1 TN pain component was reportedly improved/relieved in all Group A patients, but the Type 2 TN pain component was improved in only 7 (53.8%) of 13 patients. The mean postoperative follow-up duration was 13 months.
High-resolution 3D MR imaging reconstruction in patients with constant facial pain (Type 2 TN) can help determine the presence/absence of neurovascular compression. Surgical selection based on both clinical and radiological criteria has the potential to improve surgical outcome in patients with Type 2 TN who may potentially benefit from MVD. However, even in such selected patients, pain relief is likely to be incomplete.
三叉神经痛（TN）是一种神经病理性疼痛综合征，常与三叉神经的神经血管压迫有关，微血管减压术（MVD）可有效治疗。作者使用高分辨率 3D 重建磁共振成像（MR 成像）对持续性面部疼痛（2 型 TN）患者进行检查，以确定是否存在神经血管压迫，从而确定潜在的 MVD 获益。他们回顾性联系患者以评估结果。
本研究回顾性选择了所有报告自发性持续性面部疼痛（2 型 TN）的患者，这些患者的疼痛至少 50%时间发作，且均接受了高分辨率 3T MR 成像 3D 重建。所有患者均记录了临床病史、面部疼痛问卷数据、体格检查结果和 3T 3D MR 成像重建结果。所有接受 MVD 的患者均记录了术中发现和临床疼痛结果。
评估了 27 名患者的数据。根据病史和 3D MR 成像重建结果，选择 13 名患者接受 MVD（A 组），14 名患者接受保守治疗（B 组）。术前预测 A 组患者 100%存在典型或可疑动脉或静脉诱导的神经血管压迫，B 组患者 0%存在神经血管压迫。在 MVD 时，13 名 A 组患者中有 11 名（84.6%）患者确定存在神经血管压迫。在 13 名 A 组患者中，MVD 后面部疼痛完全缓解的有 3 名（23%），改善的有 7 名（53.8%），无改善的有 3 名（23%）。A 组患者中有 100%报告在任何时候都有阵发性（1 型 TN）疼痛，B 组患者中有 50%报告有阵发性（1 型 TN）疼痛。所有 A 组患者的 1 型 TN 疼痛均得到改善/缓解，但仅有 13 名患者中的 7 名（53.8%）的 2 型 TN 疼痛得到改善。平均术后随访时间为 13 个月。
高分辨率 3D MR 成像重建可帮助确定持续性面部疼痛（2 型 TN）患者是否存在神经血管压迫。基于临床和影像学标准的手术选择，有可能改善可能从 MVD 中获益的 2 型 TN 患者的手术结果。然而，即使在这种选择的患者中，疼痛缓解也可能不完全。
