Jafree Daniyal J, Williams Amanda C, Zakrzewska Joanna M
MBPhD Programme, Faculty of Medical Sciences, University College London, Gower Street, London, UK.
Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK.
Acta Neurochir (Wien). 2018 Jan;160(1):125-134. doi: 10.1007/s00701-017-3350-6. Epub 2017 Oct 28.
Microvascular decompression (MVD) and partial sensory rhizotomy (PSR) provide longstanding pain relief in trigeminal neuralgia (TN). Given their invasiveness, complications can result from such posterior fossa procedures, but the impact of these procedures and their complications on patient-reported outcome measures (PROM), such as quality of life and distress, are not well established.
Five years after surgery, patients who underwent first MVD or PSR for TN at one institution, between 1982 and 2002, were sent a self-completion assessment set containing a range of PROMs: the Short Form-12 (SF-12) questionnaire to assess quality of life, the Hospital Anxiety and Depression Scale (HADS) to assess distress, and a questionnaire containing questions about postoperative complications, their severity and impact on quality of life. These findings and demographic data were compared between MVD and PSR.
One hundred and eighty-one of 245 (73.9%) patients after first MVD and 49 of 60 (81.7%) after PSR responded, and were included in analyses. The mean SF-12 scores of patients after MVD and PSR at five-year follow-up were significantly lower than English age-matched norms. Though there were no differences in SF-12 physical or mental component scores between the two procedures, patients after PSR were more likely to have case-level anxiety (RR = 3.3; 95% CI, 1.1-10.5; p = 0.03), had more postoperative complications, and of greater severity, including pain (RR = 2.52; 95% CI, 1.5-4.1; p < 0.001), numbness (RR = 5.9; 95% CI, 3.8-9.2; p < 0.001), burning sensations (RR = 3.0; 95% CI, 1.5-5.8; p = 0.001) and difficulty in eating (RR = 17.1; 95% CI, 5.6-53.1; p < 0.001), and these had a larger impact on quality of life for PSR compared to MVD.
The quality of life 5 years after MVD or PSR is poorer than in the general population and associated with postoperative complications such as pain, numbness, burning sensation and difficulty in eating. These complications are commoner after PSR than MVD, and this is associated with anxiety in PSR patients at five-year follow-up. However, these differences are not reflected by quality of life scores. Outcome measures need to incorporate patient experience after treatment for TN, and represent patient priorities for quality of life.
微血管减压术（MVD）和部分感觉神经根切断术（PSR）可长期缓解三叉神经痛（TN）。鉴于其侵入性，后颅窝手术可能会引发并发症，但这些手术及其并发症对患者报告结局指标（PROM），如生活质量和痛苦程度的影响尚不明确。
对1982年至2002年间在某机构首次接受MVD或PSR治疗TN的患者，在术后五年发送一份自我完成评估套件，其中包含一系列PROM：用于评估生活质量的简明健康调查问卷（SF-12）、用于评估痛苦程度的医院焦虑抑郁量表（HADS），以及一份包含术后并发症相关问题、其严重程度及对生活质量影响的问卷。比较MVD和PSR组的这些结果及人口统计学数据。
245例首次接受MVD治疗的患者中有181例（73.9%）、60例首次接受PSR治疗的患者中有49例（81.7%）回复并纳入分析。MVD和PSR患者在五年随访时的平均SF-12评分显著低于英国年龄匹配的正常水平。尽管两种手术在SF-12身体或心理成分评分上无差异，但PSR术后患者更易出现个案水平的焦虑（相对风险[RR]=3.3；95%置信区间[CI]，1.1 - 10.5；p = 0.03），术后并发症更多且更严重，包括疼痛（RR = 2.52；95% CI，1.5 - 4.1；p < 0.001）、麻木（RR = 5.9；95% CI，3.8 - 9.2；p < 0.001）、烧灼感（RR = 3.0；95% CI，1.5 - 5.8；p = 0.001）和进食困难（RR = 17.1；95% CI，5.6 - 53.1；p < 0.001），与MVD相比，这些并发症对PSR患者生活质量的影响更大。
MVD或PSR术后五年的生活质量低于一般人群，且与疼痛、麻木、烧灼感和进食困难等术后并发症相关。这些并发症在PSR术后比MVD术后更常见，且这与PSR患者五年随访时的焦虑相关。然而，这些差异未在生活质量评分中体现出来。结局指标需要纳入TN治疗后的患者体验，并体现患者对生活质量的优先考量。
