1Department of Neurological Surgery and.
2Department of Radiation Oncology, University of California, San Francisco, California; and.
J Neurosurg. 2021 Oct 8;136(4):1119-1127. doi: 10.3171/2021.4.JNS203612. Print 2022 Apr 1.
Tumors compressing the trigeminal nerve can cause facial pain, numbness, or paresthesias. Limited data exist describing how these symptoms change after resection and what factors predict symptom improvement. The objective of this study was to report trigeminal pain and sensory outcomes after tumor resection and identify factors predicting postoperative symptom improvement.
This retrospective study included patients with tumors causing facial pain, numbness, or paresthesias who underwent resection. Trigeminal schwannomas were excluded. Logistic regression, recursive partitioning, and time-to-event analyses were used to report outcomes and identify variables associated with facial sensory outcomes.
Eighty-six patients met inclusion criteria, and the median follow-up was 3.1 years; 63 patients (73%) had meningiomas and 23 (27%) had vestibular schwannomas (VSs). Meningioma patients presented with pain, numbness, and paresthesias in 56%, 76%, and 25% of cases, respectively, compared with 9%, 91%, and 39%, respectively, for patients with VS. Most meningioma patients had symptoms for less than 1 year (60%), whereas the majority of VS patients had symptoms for 1-5 years (59%). The median meningioma and VS diameters were 3.0 and 3.4 cm, respectively. For patients with meningiomas, gross-total resection (GTR) was achieved in 27% of patients, near-total resection (NTR) in 29%, and subtotal resection (STR) in 44%. For patients with VS, GTR was achieved in 9%, NTR in 30%, and STR in 61%. Pain improved immediately after tumor resection in 81% of patients and in 92% of patients by 6 weeks. Paresthesias improved immediately in 80% of patients, increasing to 84% by 6 weeks. Numbness improved more slowly, with 52% of patients improving immediately, increasing to 79% by 2 years. Pain recurred in 22% of patients with meningiomas and 0% of patients with VSs. After resection, the Barrow Neurological Institute (BNI) facial pain intensity score improved in 73% of patients. The tumor diameter significantly predicted improvement in BNI score (OR 0.47/cm larger, 95% CI 0.22-0.99; p = 0.047). Complete decompression of the trigeminal nerve was associated with qualitative improvement in pain (p = 0.037) and decreased pain recurrence (OR 0.08, 95% CI 0.01-0.67; p = 0.024).
Most patients with facial sensory symptoms caused by meningiomas or VSs experienced improvement after resection. Surgery led to immediate and sustained improvement in pain and paresthesias, whereas numbness was slower to improve. Patients with smaller tumors and complete decompression of the trigeminal nerve were more likely to experience improvement in facial pain.
三叉神经受压可引起面部疼痛、麻木或感觉异常。目前仅有有限的数据描述这些症状在切除后的变化，以及哪些因素可预测症状改善。本研究旨在报告肿瘤切除后三叉神经疼痛和感觉结果，并确定预测术后症状改善的因素。
本回顾性研究纳入了因面部疼痛、麻木或感觉异常而接受切除手术的肿瘤患者。排除三叉神经鞘瘤患者。采用逻辑回归、递归分区和生存时间分析来报告结果，并确定与面部感觉结果相关的变量。
86 名患者符合纳入标准，中位随访时间为 3.1 年；63 名患者（73%）患有脑膜瘤，23 名（27%）患有前庭神经鞘瘤（VS）。与 VS 患者相比，脑膜瘤患者的疼痛、麻木和感觉异常发生率分别为 56%、76%和 25%，而 VS 患者分别为 9%、91%和 39%。大多数脑膜瘤患者的症状持续时间不到 1 年（60%），而大多数 VS 患者的症状持续时间为 1-5 年（59%）。脑膜瘤和 VS 的中位直径分别为 3.0cm 和 3.4cm。对于脑膜瘤患者，全切除（GTR）的比例为 27%，近全切除（NTR）的比例为 29%，次全切除（STR）的比例为 44%。对于 VS 患者，GTR 的比例为 9%，NTR 的比例为 30%，STR 的比例为 61%。81%的患者在肿瘤切除后立即缓解疼痛，92%的患者在 6 周内缓解疼痛。80%的患者立即改善感觉异常，84%的患者在 6 周内改善感觉异常。麻木缓解较慢，52%的患者立即缓解，2 年内缓解至 79%。22%的脑膜瘤患者和 0%的 VS 患者出现疼痛复发。肿瘤切除后，巴罗神经研究所（BNI）面部疼痛强度评分改善了 73%的患者。肿瘤直径显著预测 BNI 评分的改善（OR 0.47/cm，95%CI 0.22-0.99；p=0.047）。三叉神经完全减压与疼痛的定性改善相关（p=0.037），并降低疼痛复发的风险（OR 0.08，95%CI 0.01-0.67；p=0.024）。
大多数因脑膜瘤或 VS 引起面部感觉症状的患者在手术后均有改善。手术可立即和持续改善疼痛和感觉异常，而麻木改善较慢。肿瘤较小和三叉神经完全减压的患者更有可能改善面部疼痛。
