Zheng Wenhao, Dong Xiaoqiao, Wang Din, Hu Qiang, Du Quan
The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Neurosurgery, The First People's Hospital of Hangzhou, Zhejiang University School of Medicine, Hangzhou, China.
J Korean Neurosurg Soc. 2021 Nov;64(6):966-974. doi: 10.3340/jkns.2020.0315. Epub 2021 Oct 25.
To explore the clinical efficacy and safety of microvascular decompression (MVD) combined with internal neurolysis (IN) in the treatment of recurrent trigeminal neuralgia (TN) after MVD.
Sixty-four patients with recurrent TN admitted to the hospital from January 2014 to December 2017 were divided into two groups according to the surgical method. Twenty-nine patients, admitted from January 2014 to December 2015, were treated with MVD alone, whereas 35 admitted from January 2016 to December 2017 were treated with MVD+IN. The postoperative efficacy, complications, and pain recurrence rate of the two groups were analyzed.
The efficacy of the MVD+IN and MVD groups were 88.6% and 86.2%, and the cure rates were 77.1% and 65.5% respectively. There was no statistically significant difference between the two groups (p>0.05). The cure rate (83.3%) of patients in the MVD+IN group, who were only found thickened arachnoid adhesions during the operation that could not be fully released, was significantly higher than that of the MVD group (30.0%) (p<0.05), while the efficacy (91.7% vs. 70%) of the two groups was not statistically different (p>0.05). For patients whose arachnoid adhesions were completely released, there had no significant difference (p>0.05) in the efficacy (87% vs. 94.7%) and recurrence rate (5.0% vs. 11.1%). The incidence of postoperative facial numbness (88.6%) in the MVD+IN group was higher than that in the MVD group (10.3%) (p<0.01). The long-term incidence of facial numbness was not statistically significant (p>0.05). In the 18-36 months follow-up, the recurrence rate of patients in the MVD+IN group (9.7%) and in the MVD group (16%) were not statistically different (p>0.05).
A retrospective comparison of patients with recurrent TN showed that both MVD and MVD combined with IN can effectively treat recurrent TN. Compared with MVD alone, MVD combined with IN can effectively improve the pain cure rate of patients with recurrent TN who have only severe arachnoid adhesions. The combination does not increase the incidence of long-term facial numbness and other complications.
探讨微血管减压术（MVD）联合神经内松解术（IN）治疗MVD术后复发三叉神经痛（TN）的临床疗效及安全性。
将2014年1月至2017年12月收治的64例复发TN患者按手术方式分为两组。2014年1月至2015年12月收治的29例患者单纯行MVD治疗，而2016年1月至2017年12月收治的35例患者行MVD+IN治疗。分析两组患者术后疗效、并发症及疼痛复发率。
MVD+IN组和MVD组的有效率分别为88.6%和86.2%，治愈率分别为77.1%和65.5%。两组间差异无统计学意义（p>0.05）。MVD+IN组中术中仅发现蛛网膜粘连增厚且无法完全松解的患者治愈率（83.3%）显著高于MVD组（30.0%）（p<0.05），而两组有效率（91.7%对70%）差异无统计学意义（p>0.05）。对于蛛网膜粘连完全松解的患者，疗效（87%对94.7%）和复发率（5.0%对11.1%）差异无统计学意义（p>0.05）。MVD+IN组术后面部麻木发生率（88.6%）高于MVD组（10.3%）（p<0.01）。面部麻木的长期发生率差异无统计学意义（p>0.05）。在18 - 36个月的随访中，MVD+IN组患者复发率（9.7%）与MVD组（16%）差异无统计学意义（p>0.05）。
对复发TN患者的回顾性比较表明，MVD及MVD联合IN均可有效治疗复发TN。与单纯MVD相比，MVD联合IN可有效提高仅存在严重蛛网膜粘连的复发TN患者的疼痛治愈率。联合治疗未增加长期面部麻木等并发症的发生率。
