Service ORL et CCF, hôpital Robert-Debré, CHU de Reims, 51100 Reims, France.
Service de neurochirurgie, hôpital Maison-Blanche, CHU de Reims, 51100 Reims, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2020 Sep;137(4):285-289. doi: 10.1016/j.anorl.2019.09.008.
Analysis of the long-term efficacy of microvascular decompression surgery in trigeminal neuralgia.
A single-center retrospective study included patients undergoing microvascular decompression surgery for trigeminal neuralgia after failure of well-conducted medical or complementary therapy, with visualization of nerve compression syndrome on MRI.
Eighty-seven patients were included. Nerve compression was alleviated without interposition of polytetrafluoroethylene in 79.3% of cases. Postoperative efficacy on pain was immediate in 97.7% of cases. There were no postoperative deaths, and the rate of severe complications was low (2.3%). The efficacy of microvascular decompression surgery was total at 2 years in 90.8% of cases and at 10 years in 92.3%, without resumption of medical treatment. The failure rate was 10.3%; 26.3% of these patients had been previously treated by a lesional technique (P: 0.043) and 33.3% by interposition of polytetrafluoroethylene (P: 0.003).
With confirmed clinical and radiological diagnosis, microvascular decompression surgery for trigeminal nerve compression was safe, with total effectiveness in the immediate, short and long terms. It should be considered in first line in case of failure or intolerance of well-conducted medical treatment.
分析微血管减压手术治疗三叉神经痛的长期疗效。
单中心回顾性研究纳入了因充分的药物或辅助治疗失败后，经 MRI 显示存在神经压迫综合征而接受微血管减压手术治疗三叉神经痛的患者。
共纳入 87 例患者。79.3%的病例在无聚四氟乙烯介入的情况下神经压迫得到缓解。97.7%的病例术后疼痛即刻缓解。无术后死亡，严重并发症发生率低（2.3%）。微血管减压手术的 2 年总有效率为 90.8%，10 年总有效率为 92.3%，无需再次药物治疗。失败率为 10.3%；其中 26.3%的患者曾接受过病灶治疗（P：0.043），33.3%的患者曾接受过聚四氟乙烯介入（P：0.003）。
在明确的临床和影像学诊断下，微血管减压术治疗三叉神经压迫是安全的，在即时、短期和长期均有良好的疗效。对于充分的药物治疗失败或不耐受的患者，应考虑作为一线治疗。
