Wang Junwen, Niu Hongquan, Zhao Kai, Shu Kai, Lei Ting
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Neurol. 2021 Apr 28;12:634945. doi: 10.3389/fneur.2021.634945. eCollection 2021.
Compared with trigeminal neuralgia (TN) caused by arterial neurovascular conflict (NVC), the clinical characteristics and managements for TN with venous NVC are not well-established. This study aims to comparatively summarize the clinical features and surgical outcomes of microvascular decompression (MVD) for patients with TN caused by sole arterial and venous compression, with a particular focus on the morphological features of posterior cranial fossa (PCF). A total of 222 patients with TN caused by sole arterial NVC (188/84.7%) and venous NVC (34/15.3%) underwent MVD in our department from January 2014 to December 2018. The patient data were analyzed retrospectively. Particularly, we focused on the potential impact of PCF on surgical outcomes. Compared with arterial NVC, V3 branch of the trigeminal nerve was more frequently involved in venous NVC ( = 0.009). The most common compression site was root entry zone for arterial NVC (68.6%) and midcisternal segment for venous NVC (76.5%) ( < 0.001). No serious post-operative complication was observed in the two groups. Both short- and long-term outcomes were relatively worse in venous NVC cases compared with arterial NVC cases ( = 0.001 and = 0.030, respectively); and a dominantly higher rate of delayed cure was demonstrated in venous NVC cases ( < 0.001). TN patients with venous NVC revealed a more flat-shaped PCF than those with arterial NVC. Moreover, flat-shaped PCF morphometry was negatively correlated with surgical outcomes of TN patients with arterial NVC, but not with those of venous NVC cases. MVD is an effective and safe treatment for patients with TN caused by either arterial or venous NVC. Patients with a more flat-shaped PCF might be vulnerable to venous compression. Our study demonstrated that PCF morphometry only affected the surgical outcomes of patients with TN caused by arterial NVC, but not the outcomes of those with venous NVC.
与动脉性神经血管冲突（NVC）所致的三叉神经痛（TN）相比，静脉性NVC所致TN的临床特征及治疗方法尚未完全明确。本研究旨在比较总结单纯动脉压迫和静脉压迫所致TN患者行微血管减压术（MVD）的临床特征及手术结果，特别关注后颅窝（PCF）的形态学特征。2014年1月至2018年12月，共有222例单纯动脉性NVC（188例/84.7%）和静脉性NVC（34例/15.3%）所致TN患者在我科接受了MVD。对患者数据进行回顾性分析。特别地，我们关注PCF对手术结果的潜在影响。与动脉性NVC相比，三叉神经V3分支在静脉性NVC中更常受累（ = 0.009）。动脉性NVC最常见的压迫部位是神经根入区（68.6%），静脉性NVC是脑池中段（76.5%）（ < 0.001）。两组均未观察到严重的术后并发症。与动脉性NVC病例相比，静脉性NVC病例的短期和长期结果相对较差（分别为 = 0.001和 = 0.030）；静脉性NVC病例的延迟治愈发生率明显更高（ < 0.001）。静脉性NVC的TN患者PCF形态比动脉性NVC的患者更扁平。此外，扁平形PCF形态测量与动脉性NVC的TN患者手术结果呈负相关，但与静脉性NVC病例的手术结果无关。MVD对动脉性或静脉性NVC所致TN患者是一种有效且安全的治疗方法。PCF形态更扁平的患者可能更容易受到静脉压迫。我们的研究表明，PCF形态测量仅影响动脉性NVC所致TN患者的手术结果，而不影响静脉性NVC患者的手术结果。
