1 Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Denmark.
2 Department of Neurosurgery, Rigshospitalet Blegdamsvej, University of Copenhagen, Denmark.
Cephalalgia. 2019 Feb;39(2):197-208. doi: 10.1177/0333102418783294. Epub 2018 Jun 13.
There is a lack of high-quality prospective, systematic studies using independent assessors of outcome of microvascular decompression as treatment for trigeminal neuralgia.
Clinical characteristics and outcome data were recorded prospectively from consecutive classical trigeminal neuralgia patients, using standardized interviews. Degree of neurovascular contact was evaluated by a 3.0 Tesla MRI blinded to symptomatic side. Patients were assessed before and 12 months after surgery by a neurologist.
Twenty-six men and 33 women completed 12 months follow-up. Forty-one patients (69%) had an excellent outcome (no pain, no medication). Ten (18%) patients had a good outcome. Eight (12%) patients had no improvement or had worsening of pain. MRI showed neurovascular contact with morphological changes in 34 patients (58%). Odds ratio between neurovascular contact with morphological changes and excellent outcome was 4.4 (Cl 1.16-16.26), p = 0.029. Odds ratio between male sex and excellent outcome was 11.38 (Cl 2.12-59.52), p = 0.004. No significant association was found between excellent outcome and concomitant persistent pain, current age or disease duration.
Neurovascular contact with morphological changes and male sex are positive predictive factors for outcome of microvascular decompression. The findings enable clinicians to better inform patients before surgery.
缺乏使用独立评估者对微血管减压术治疗三叉神经痛的结果进行前瞻性、系统性的高质量研究。
连续的经典三叉神经痛患者的临床特征和结果数据通过标准化访谈进行前瞻性记录。使用 3.0T MRI 对神经血管接触程度进行评估，该评估对症状侧是盲法的。患者在手术前和手术后 12 个月由神经科医生进行评估。
26 名男性和 33 名女性完成了 12 个月的随访。41 名患者（69%）有极好的结果（无疼痛，无需药物治疗）。10 名患者（18%）有良好的结果。8 名患者（12%）没有改善或疼痛恶化。MRI 显示 34 名患者（58%）存在神经血管接触和形态学变化。神经血管接触伴形态学变化与极好结果之间的优势比为 4.4（Cl 1.16-16.26），p=0.029。男性与极好结果之间的优势比为 11.38（Cl 2.12-59.52），p=0.004。极好的结果与持续性疼痛、当前年龄或疾病持续时间之间没有显著关联。
神经血管接触伴形态学变化和男性是微血管减压术结果的阳性预测因素。这些发现使临床医生能够在手术前更好地告知患者。
