Bigder Mark G, Krishnan Sandeep, Cook E Francis, Kaufmann Anthony M
1Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; and.
2Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
J Neurosurg. 2018 Jul 13;130(6):1877-1888. doi: 10.3171/2017.12.JNS171647. Print 2019 Jun 1.
Patients with multiple sclerosis (MS)-associated trigeminal neuralgia (TN) have higher recurrence and retreatment rates than non-MS patients. The optimal management strategy and role for microsurgical rhizotomy (MSR) for MS-TN remains to be determined. The aim of this study was to report time to treatment failure (TTF) and pain scores following MSR compared to percutaneous and Gamma Knife procedures.
Time to treatment failure was analyzed after MSR (n = 14) versus prior procedures (n = 53) among MS-TN patients. Kaplan-Meier curves and log-rank test were utilized to compare TTF after MSR versus prior procedures using the same cohort of patients as their own control group. Subsequent analysis compared TTF after MSR to TTF after 93 other procedures among a second cohort of 18 MS-TN patients not undergoing MSR. BNI pain scores were compared between MSR and other procedures among the MS-TN cohort using a chi-square test.
TTF was significantly longer after MSR than after other procedures in the MSR cohort (median TTF 79 vs 10 months, respectively, p < 0.0001). Similarly, TTF was longer after MSR than after prior procedures in the non-MSR cohort (median TTF 79 vs 13 months, respectively, p < 0.001). MSR resulted in a higher proportion of excellent pain scores when compared to other procedures in the non-MSR cohort (77% vs 29%, p < 0.001). Probability of treatment survival was higher after MSR than after other procedures at all time points (3, 6, 12, 24, 36, and 48 months). There were no deaths or major complications after MSR.
TTF was significantly longer following MSR compared to prior procedures in MS-TN patients. Additionally, a higher proportion of patients achieved excellent BNI pain scores after MSR.
与非多发性硬化症（MS）患者相比，患有MS相关性三叉神经痛（TN）的患者复发率和再次治疗率更高。MSR治疗MS-TN的最佳管理策略和作用仍有待确定。本研究的目的是报告与经皮和伽玛刀手术相比，MSR后的治疗失败时间（TTF）和疼痛评分。
分析了MS-TN患者中MSR组（n = 14）与先前手术组（n = 53）的治疗失败时间。使用Kaplan-Meier曲线和对数秩检验，以同一组患者作为自身对照组，比较MSR组与先前手术组的TTF。随后的分析将18例未接受MSR的MS-TN患者组成的第二组中MSR后的TTF与93例其他手术后的TTF进行了比较。使用卡方检验比较MS-TN队列中MSR与其他手术之间的BNI疼痛评分。
在MSR队列中，MSR后的TTF明显长于其他手术（中位TTF分别为79个月和10个月，p < 0.0001）。同样，在非MSR队列中，MSR后的TTF也长于先前手术（中位TTF分别为79个月和13个月，p < 0.001）。与非MSR队列中的其他手术相比，MSR导致优秀疼痛评分的比例更高（77%对29%，p < 0.001）。在所有时间点（3、6、12、24、36和48个月），MSR后的治疗生存率均高于其他手术。MSR后无死亡或重大并发症。
与先前手术相比，MS-TN患者接受MSR后的TTF明显更长。此外，MSR后达到优秀BNI疼痛评分的患者比例更高。
