Ichida Michelle Cristina, de Almeida Antonio Nogueira, da Nobrega Jose Claudio Marinho, Teixeira Manoel Jacobsen, de Siqueira José Tadeu Tesseroli, de Siqueira Silvia R D T
1Neurology Department, Medical School, University of São Paulo;
5Functional Neurosurgery Division, Institute of Psychiatry, Hospital das Clinicas, Medical School, University of São Paulo, Brazil.
J Neurosurg. 2015 Jun;122(6):1315-23. doi: 10.3171/2014.9.JNS14346. Epub 2015 Apr 3.
Idiopathic trigeminal neuralgia (iTN) is a neurological condition treated with pharmacotherapy or neurosurgery. There is a lack of comparative papers regarding the outcomes of neurosurgery in patients with iTN. The objective of this study was to investigate sensory thresholds and masticatory function in 78 patients with iTN who underwent microvascular decompression (MVD) or balloon compression (BC), and compare these treatments with carbamazepine and 30 untreated healthy controls.
The authors conducted a case-controlled longitudinal study. Patients were referred to 1 of 3 groups: MVD, BC, or carbamazepine. All patients were evaluated before and after treatment with a systematic protocol composed of a clinical orofacial questionnaire, Research Diagnostic Criteria for temporomandibular disorders, Helkimo indices, and a quantitative sensory-testing protocol (gustative, olfactory, cold, warm, touch, vibration, superficial, and deep pain thresholds).
Both MVD and BC were effective at reducing pain intensity (p = 0.012) and carbamazepine doses (p < 0.001). Myofascial and articular complaints decreased in both groups (p < 0.001), but only the patients in the MVD group showed improvement in Helkimo indices (p < 0.003). Patients who underwent MVD also showed an increase in sweet (p = 0.014) and salty (p = 0.003) thresholds. The sour threshold decreased (p = 0.003) and cold and warm thresholds increased (p < 0.001) in patients after MVD and BC, but only the patients who underwent BC had an increase in touch threshold (p < 0.001).
Microvascular decompression and BC resulted in a reduction in myofascial and jaw articular complaints, and the impact on masticatory function according to Helkimo indices was greater after BC than MVD. MVD resulted in more gustative alterations, and both procedures caused impairment in thermal thresholds (warm and cold). However, only BC also affected touch perception. The sensorial and motor deficits after BC need to be included as targets directly associated with the success of the surgery and need to be assessed and relieved as goals in the treatment of iTN.
特发性三叉神经痛（iTN）是一种采用药物治疗或神经外科手术治疗的神经系统疾病。关于iTN患者神经外科手术结果的比较性论文较少。本研究的目的是调查78例接受微血管减压术（MVD）或球囊压迫术（BC）的iTN患者的感觉阈值和咀嚼功能，并将这些治疗方法与卡马西平及30名未经治疗的健康对照者进行比较。
作者进行了一项病例对照纵向研究。患者被分为3组中的1组：MVD组、BC组或卡马西平组。所有患者在治疗前后均按照由临床口腔面部问卷、颞下颌关节紊乱研究诊断标准、Helkimo指数以及定量感觉测试方案（味觉、嗅觉、冷觉、温觉、触觉、振动觉、浅感觉和深痛觉阈值）组成的系统方案进行评估。
MVD和BC在减轻疼痛强度（p = 0.012）和降低卡马西平剂量（p < 0.001）方面均有效。两组的肌筋膜和关节主诉均减少（p < 0.001），但只有MVD组患者的Helkimo指数有所改善（p < 0.003）。接受MVD的患者甜味（p = 0.014）和咸味（p = 0.003）阈值也有所升高。MVD和BC后患者的酸味阈值降低（p = 0.003），冷觉和温觉阈值升高（p < 0.001），但只有接受BC的患者触觉阈值升高（p < 0.001）。
微血管减压术和球囊压迫术可减少肌筋膜和颌关节主诉，根据Helkimo指数，球囊压迫术对咀嚼功能的影响大于微血管减压术。微血管减压术导致更多的味觉改变，两种手术均导致热觉阈值（温觉和冷觉）受损。然而，只有球囊压迫术也影响触觉感知。球囊压迫术后的感觉和运动缺陷需要作为与手术成功直接相关的目标纳入考量，并需要在iTN治疗中作为目标进行评估和缓解。
