Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy.
Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Neurosurg Rev. 2022 Feb;45(1):285-294. doi: 10.1007/s10143-021-01606-1. Epub 2021 Jul 26.
Trigeminal neuralgia (TN) caused by vertebrobasilar artery (VBA) compression is a rare event, reported between 2 and 6% (Linskey et al. J Neurosurg 81:1-9,1992, Vanaclocha et al.World Neurosurg 96:516-529,2016) of the time. Microvascular decompression (MVD) is advised for drug-resistant pain and, although technically challenging, is associated with an excellent outcome in current literature (Apra et al.Neurosurg Rev 40:577-582,2017, Cruccuet al. EurJ Neurol 15:1013-1028,2008, Linskey et al. J Neurosurg 81:1-9,1992). The authors performed a systematic review and meta-analysis of the literature examining the rate of MVD for trigeminal neuralgia caused by VBA compression and the post-operative outcome. The systematic search of three databases was performed for studies published between January 1990 and October 2020. Random-effects meta-analysis was used to pool the analyzed outcomes, and random-effects meta-regression was used to examine the association between the effect size and potential confounders. Funnel plot followed by Egger's linear regression was used to test publication bias. We included 9 studies, and the overall rate of TN due to VBA compression was 3.4% (95% CI 2.5-4.3%, p < 0.01, I = 67.9%) among all MVD for TN. Immediately after surgery, 96% (p < 0.01, I = 0%) of patients were pain-free, and at last follow-up, approximately 93% (p < 0.01, I = 0%) of patients were classified as BNI I-II. Hearing impairment and facial numbness were the most common long-term complications ensuing MVD for VBA compression (5% and 13%, respectively). In conclusion, the surgical management of trigeminal neuralgia caused by VBA compression is associated with good outcome and low rate of post-operative complications. Further studies are needed to analyze the long-term results and the rate of pain recurrence among this population.
三叉神经痛（TN）由椎基底动脉（VBA）压迫引起是一种罕见的情况，约占所有 TN 病例的 2%至 6%（Linskey 等人，J Neurosurg 81:1-9,1992；Vanaclocha 等人，World Neurosurg 96:516-529,2016）。对于药物难治性疼痛，建议进行微血管减压术（MVD），尽管技术上具有挑战性，但在当前文献中与极好的结果相关（Apra 等人，Neurosurg Rev 40:577-582,2017；Cruccu 等人，EurJ Neurol 15:1013-1028,2008；Linskey 等人，J Neurosurg 81:1-9,1992）。作者对检查 VBA 压迫引起的三叉神经痛的 MVD 发生率和术后结果的文献进行了系统回顾和荟萃分析。对 1990 年 1 月至 2020 年 10 月期间发表的研究进行了三个数据库的系统搜索。使用随机效应荟萃分析来汇总分析结果，并使用随机效应荟萃回归来检查效应大小与潜在混杂因素之间的关联。使用漏斗图随后进行 Egger 的线性回归来测试发表偏倚。我们纳入了 9 项研究，在所有 TN 的 MVD 中，VBA 压迫引起的 TN 总体发生率为 3.4%（95%CI 2.5-4.3%，p<0.01，I=67.9%）。手术后立即，96%（p<0.01，I=0%）的患者无痛，在最后一次随访时，约 93%（p<0.01，I=0%）的患者被归类为 BNI I-II。听力障碍和面部麻木是 VBA 压迫 MVD 后最常见的长期并发症（分别为 5%和 13%）。总之，VBA 压迫引起的三叉神经痛的手术治疗具有良好的效果和较低的术后并发症发生率。需要进一步研究来分析该人群的长期结果和疼痛复发率。
