Jafree Daniyal J, Zakrzewska Joanna M
a Faculty of Medical Sciences , University College London , London , UK.
b Oral Medicine Unit, Eastman Dental Institute , UCLH NHS Foundation Trust , London , UK.
Br J Neurosurg. 2019 Feb;33(1):31-36. doi: 10.1080/02688697.2018.1538484. Epub 2018 Nov 19.
Management strategies for the recurrence of trigeminal neuralgia after microvascular decompression include repeat procedures, medical management or no further therapy. No consensus exists as to which strategy is best for pain relief. The aim of this study was to determine the characteristics of patients with recurrences after microvascular decompression in the cohort, and to compare long-term pain relief between different management strategies.
A historical cohort of patients who underwent microvascular decompression at a neurosurgical institution between 1982-2002, followed up by postal survey at five years, was included. Characteristics of patients who experienced a recurrence were compared to those who were recurrence free, and pain relief was compared between each management strategy.
From 169 responders who were included in the study, 28 (16.6%) experienced a recurrence after MVD. No characteristics were significantly different between patients who experienced a recurrence and those who did not. Repeat procedures, including repeat microvascular decompression, partial sensory rhizotomy or radiofrequency thermocoagulation, yielded the highest proportion of pain relief after recurrence (p = 0.031), with 63.6% of patients pain-free at five-years. There was no evidence to suggest that the choice of repeat procedure influenced the likelihood of pain relief after recurrence. No further treatment yielded 57.1% pain-free, whereas medical therapy had the lowest proportion of pain-free patients, at 10.0%.
A variety of options are available to patients for recurrence of TN after microvascular decompression with repeat procedures yielding the greatest likelihood of long-term pain relief in this historical cohort. The choice of management should consider the mechanism of recurrence, the benefits and risks of each option and the severity of the pain. Regardless of the management strategy selected, careful phenotyping of patients before and after surgery is paramount.
微血管减压术后三叉神经痛复发的管理策略包括再次手术、药物治疗或不再进一步治疗。对于哪种策略最有利于缓解疼痛尚无共识。本研究的目的是确定该队列中微血管减压术后复发患者的特征，并比较不同管理策略之间的长期疼痛缓解情况。
纳入一个历史队列，该队列中的患者于1982年至2002年间在一家神经外科机构接受了微血管减压术，并在五年后通过邮寄调查进行随访。将经历复发的患者的特征与未复发的患者进行比较，并比较每种管理策略之间的疼痛缓解情况。
在纳入研究的169名应答者中，28名（16.6%）在微血管减压术后复发。经历复发的患者与未复发的患者之间没有显著不同的特征。再次手术，包括再次微血管减压、部分感觉神经根切断术或射频热凝术，在复发后产生疼痛缓解的比例最高（p = 0.031），五年时63.6%的患者无痛。没有证据表明再次手术的选择会影响复发后疼痛缓解的可能性。不再进一步治疗的患者中有57.1%无痛，而药物治疗的无痛患者比例最低，为10.0%。
对于微血管减压术后三叉神经痛复发的患者，有多种选择，在这个历史队列中，再次手术产生长期疼痛缓解的可能性最大。管理方式的选择应考虑复发机制、每种选择的益处和风险以及疼痛的严重程度。无论选择何种管理策略，术前和术后对患者进行仔细的表型分析至关重要。
