Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2020 Nov;143:e70-e77. doi: 10.1016/j.wneu.2020.06.206. Epub 2020 Jul 13.
Microvascular decompression (MVD) has remained the first-line surgical treatment of trigeminal neuralgia when an offending vessel can be identified that is causing neurovascular compression. However, patients without neurovascular compression can either develop trigeminal neuralgia or recurrence after MVD. In addition, patients with venous and less severe arterial compression have been shown to have reduced efficacy after MVD. Internal neurolysis is a surgical technique used to separate the fascicles of the trigeminal nerve and might be a good option for patients with trigeminal neuralgia but without vascular compression.
A retrospective, institutional review board-approved medical record review was performed of adult patients with trigeminal neuralgia who had undergone internal neurolysis. The search resulted in 32 patients who had been treated from 2016 to 2019. The Barrow Neurological Institute (BNI) pain intensity scale and hypesthesia scale (HS) were used to determine the outcomes.
The average follow-up was 20 months (range, 3-40 months). The postoperative outcomes showed a BNI pain intensity scale score of I for 50%, with excellent control in 56%, successful control in 78%, adequate control in 94%, and poor control in 6%. Significantly more patients without previous treatment had had successful pain control (95% vs. 54%). Six patients (19%) experienced pain recurrence and were significantly more likely to experience pain recurrence compared with patients without a previous procedure (39% vs. 5%). The overall BNI-HS score postoperatively was I for 28%, II for 69%, and III for 3%.
Internal neurolysis with and without MVD has shown efficacy in treating trigeminal neuralgia in carefully selected patients.
微血管减压术（MVD）仍然是可识别导致神经血管压迫的致病血管的三叉神经痛的一线手术治疗方法。然而，没有神经血管压迫的患者要么会发展为三叉神经痛，要么在 MVD 后复发。此外，已经表明静脉和较轻的动脉压迫患者在 MVD 后疗效降低。神经内松解术是一种用于分离三叉神经根束的手术技术，对于没有血管压迫但患有三叉神经痛的患者可能是一个不错的选择。
对 2016 年至 2019 年间接受神经内松解术的三叉神经痛成年患者进行了回顾性、机构审查委员会批准的病历回顾。搜索结果为 32 名患者。使用巴罗神经研究所（BNI）疼痛强度量表和感觉迟钝量表（HS）来确定结果。
平均随访时间为 20 个月（范围，3-40 个月）。术后结果显示 BNI 疼痛强度量表评分为 I 的占 50%，控制良好的占 56%，成功控制的占 78%，充分控制的占 94%，控制不佳的占 6%。未经先前治疗的患者有更好的成功疼痛控制（95% vs. 54%）。6 名患者（19%）出现疼痛复发，与无先前手术的患者相比，疼痛复发的可能性明显更高（39% vs. 5%）。术后总体 BNI-HS 评分为 I 的占 28%，II 的占 69%，III 的占 3%。
MVD 联合或不联合神经内松解术在精心挑选的患者中治疗三叉神经痛显示出疗效。
