Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Neurological Surgery, University of Washington Medical Center, Seattle, Washington.
Neurosurgery. 2019 Sep 1;85(3):E553-E559. doi: 10.1093/neuros/nyz048.
In trigeminal neuralgia type 1 (TN1), neurovascular compression (NVC) is often assumed to be the pain initiating mechanism. NVC can be surgically addressed by microvascular decompression (MVD). However, some patients with TN1 present without NVC (WONVC).
To characterize and analyze the clinical spectrum of a TN1 patient population WONVC.
A retrospective chart review of patients presenting with TN1 between 2007 and 2017 was performed. Patients who were potential candidates for MVD surgery underwent high-resolution imaging with 3-dimensional (3D) reconstruction to address the presence, or absence, of NVC. Demographic data about the populations with NVC (WNVC) and WONVC were collected.
Of 242 patients with TN1, 32% did not have NVC. Patients WONVC were on average 10.6 yr younger than those WNVC. TN1 onset in patients WONVC was more frequent below 48.7 yr, and the opposite was found in patients WNVC. Compared to patients WNVC, those WONVC were predominantly female (odds ratio 4.8), on average were 4 yr younger at symptom onset (34.7 yr) and 7.8 yr younger at first clinic visit, and had a 3.7 yr shorter symptom duration.
Patients presenting with TN1 WONVC were predominantly females in their mid-30s with short symptom duration. In the absence of NVC, this subgroup of TN1 patients has limited surgical options, and potentially a longer condition duration that must be managed medically or surgically. This population WONVC might provide insights into the true pathophysiology of TN1.
在 1 型三叉神经痛（TN1）中，神经血管压迫（NVC）通常被认为是疼痛的起始机制。NVC 可以通过微血管减压术（MVD）进行手术治疗。然而，一些患有 TN1 的患者没有 NVC（WONVC）。
描述和分析无 NVC 的 TN1 患者人群的临床特征。
对 2007 年至 2017 年间就诊的 TN1 患者进行回顾性病历分析。对有 MVD 手术潜在可能的患者进行高分辨率影像学检查，包括三维（3D）重建，以确定是否存在 NVC。收集有 NVC（WNVC）和无 NVC（WONVC）患者的人口统计学数据。
在 242 名 TN1 患者中，有 32%的患者没有 NVC。WONVC 患者的平均年龄比 WNVC 患者小 10.6 岁。WONVC 患者的 TN1 发病年龄低于 48.7 岁的比例较高，而 WNVC 患者的发病年龄高于 48.7 岁的比例较高。与 WNVC 患者相比，WONVC 患者主要为女性（优势比 4.8），症状发作时的平均年龄小 4 岁（34.7 岁），首次就诊时小 7.8 岁，症状持续时间短 3.7 年。
无 NVC 的 TN1 患者主要为 30 多岁的女性，症状持续时间较短。在没有 NVC 的情况下，这组 TN1 患者的手术选择有限，而且病情可能会持续更长时间，需要进行药物或手术治疗。这一无 NVC 的 TN1 患者亚组可能为 TN1 的真正病理生理学提供了新的见解。
