Xia Lei, Zhong Jun, Zhu Jin, Wang Yong-Nan, Dou Ning-Ning, Liu Ming-Xing, Visocchi Massimiliano, Li Shi-Ting
From the *Department of Neurosurgery, XinHua Hospital (The Cranial Nerve Disease Center of Shanghai), Shanghai JiaoTong University School of Medicine, Shanghai, China; and †Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
J Craniofac Surg. 2014 Jul;25(4):1413-7. doi: 10.1097/SCS.0000000000000984.
Microvascular decompression has been now accepted worldwide as a reasonable treatment for trigeminal neuralgia, yet, as a functional operation in the cerebellopontine angle, this process may be risky and the postoperative outcomes might not be good enough sometimes. To assess the effectiveness and safety of microvascular decompression for treatment of trigeminal neuralgia, we conducted a systematic review. Using the keywords "trigeminal neuralgia", "microvascular decompression", or "neurovascular conflict", manuscripts published in English-language journals and indexed in PubMed between January 1, 2000 and June 1, 2013 on the treatment of trigeminal neuralgia (TN) with microvascular decompression were considered for this study. The success and complications were analyzed. The success in this investigation was defined as complete pain free. Continuous outcomes were summarized using means or medians, and dichotomous outcomes were presented as percentage associated with 95% confidence interval. Twenty-six papers with 6,847 patients were finally enrolled in this review. Among them, the male-to-female ratio was 1:1.4, the left-to-right ratio was 1:1.6, and the pain was located in the innervation of V3 and/or V2 in most of the cases with only 2.3% (0.1-4.7) of V1 exclusively. The average age at surgery was 60.9 years (52.5-64.1) with TN symptoms duration of 24.7 months (6.1-42.1) before microvascular decompression (MVD). Operative findings confirmed the superior cerebellar artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery, and multiple vascular contacts (including veins) as the most common sources of nerve compression. The average follow-up duration was 35.8 months (26.2-56.6). The success rate was 83.5% (79.6-89.1). Complications included incisional infection in 1.3% (0.1-2.5), facial palsy 2.9% (0.5-6.2), facial numbness 9.1% (1.3-19.6), cerebrospinal fluid leak 1.6% (0.7-2.5), and hearing deficit 1.9% (0.2-3.9). The postoperative mortality was 0.1% (0.02-0.2). Accordingly, MVD is the most effective treatment for patients with trigeminal neuralgia. An immediate pain free can be achieved by an experienced neurosurgeon with good knowledge of the regional anatomy. To avoid complications, each single step of the process cannot be overemphasized.
微血管减压术目前已被全球公认为治疗三叉神经痛的一种合理方法，然而，作为一种在桥小脑角进行的功能性手术，该过程可能存在风险，且术后效果有时可能不尽人意。为评估微血管减压术治疗三叉神经痛的有效性和安全性，我们进行了一项系统评价。使用关键词“三叉神经痛”“微血管减压术”或“神经血管冲突”，检索2000年1月1日至2013年6月1日期间发表在英文期刊且被PubMed收录的关于微血管减压术治疗三叉神经痛（TN）的手稿纳入本研究。分析手术成功率和并发症情况。本研究中的成功定义为完全无痛。连续型结局采用均值或中位数进行总结，二分法结局以百分比及95%置信区间呈现。最终26篇论文共纳入6847例患者。其中，男女比例为1:1.4，左右侧比例为1:1.6，大多数病例疼痛位于V3和/或V2支配区域，仅2.3%（0.1 - 4.7）仅累及V1。手术平均年龄为60.9岁（52.5 - 64.1），微血管减压术（MVD）前三叉神经痛症状持续时间为24.7个月（6.1 - 42.1）。手术发现小脑上动脉、小脑前下动脉、小脑后下动脉以及多处血管压迫（包括静脉）是最常见的神经压迫来源。平均随访时间为35.8个月（26.2 - 56.6）。成功率为83.5%（79.6 - 89.1）。并发症包括切口感染1.3%（0.1 - 2.5）、面神经麻痹2.9%（0.5 - 6.2）、面部麻木9.1%（1.3 - 19.6）、脑脊液漏1.6%（0.7 - 2.5）以及听力减退1.9%（0.2 - 3.9）。术后死亡率为0.1%（0.02 - 0.2）。因此，微血管减压术是三叉神经痛患者最有效的治疗方法。经验丰富且熟悉局部解剖的神经外科医生可实现即刻无痛。为避免并发症，手术过程中的每一个步骤都至关重要。
