Center of Pain Medicine, Department of Anesthesiology, pain, and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Pain Physician. 2021 Dec;24(8):E1255-E1262.
Recurrent trigeminal neuralgia (TN) after surgical operations can be quite difficult to treat, and treatment measures have not been standardized. Patients often have long-term, repeated severe pain, which may easily cause anxiety and depression and can exert a negative effect on the quality of life. Despite the known efficacy of percutaneous balloon compression (PBC) for TN, it is unclear whether PBC can be used as the preferred surgical treatment for postoperative recurrent TN and effectively improve patients' negative emotions.
This study aimed to evaluate the clinical curative effect of PBC in patients with postoperative recurrent TN and analyze the improvement in conditions such as anxiety, depression, and sleep disorders.
Retrospective study.
Center of Pain Medicine, Department of Anesthesiology, pain, and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University.
Clinical data from 121 postoperative recurrent TN patients who underwent PBC between August 2017 and June 2019 were retrospectively reviewed and analyzed. The Barrow Neurological Institute pain intensity (BNI-P) score was used to measure the severity of pain. The Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) were used to evaluate anxiety, depression, and sleep status.
On postoperative day 1, 104 patients (86.0%) reported no pain, 9 patients (7.4%) had occasional pain that did not require medication, and 8 patients (6.6%) experienced no significant pain relief. The total efficacy was 93.4%. Moreover, 3 patients (2.5%) reported significant pain relief 2 weeks postoperatively. Within a follow-up time of 12 months, 101 (83.5%) patients remained pain-free, while 5 patients (4.1%) experienced recurrence. Taking into account economic factors, the patients were tolerant to pain after taking medication and did not undergo repeated PBC. Forty-six patients (38.0%) suffered from anxiety, 70 patients (57.9%) had depression, and 62 patients (51.2%) had poor sleep quality preoperatively. There were significant improvements in anxiety, depression, and sleep status postoperatively compared with preoperatively. Postoperative side effects included facial numbness in 115 patients (95.0%), masticatory muscle weakness in 86 patients (71.1%), herpes simplex in 18 patients (14.9%), and diplopia secondary to abducens nerve palsy in 2 patients (1.7%). None of the patients had corneal anesthesia, anesthesia dolorosa, aseptic meningitis, cerebrospinal fluid leakage, subarachnoid hemorrhage, carotid cavernous fistula, or death in this study.
This study was a single-center retrospective study, the sample size was small, and the follow-up time was relatively short. Therefore, the long-term efficacy of PBC for postoperative recurrent TN needs further evaluation from multiple centers with a large sample size and long-term follow-up.
PBC is a minimally invasive, safe, and effective procedure. Moreover, it significantly improves the symptoms of anxiety, depression, and sleep quality caused by TN, so it appears to be regarded as an optimized choice for patients with recurrent TN after surgical procedures.
手术后复发性三叉神经痛（TN）的治疗相当困难，治疗措施尚未标准化。患者往往长期、反复出现严重疼痛，容易导致焦虑和抑郁，对生活质量产生负面影响。尽管已知经皮球囊压迫（PBC）对 TN 有效，但尚不清楚 PBC 是否可以作为术后复发性 TN 的首选手术治疗方法，以及是否可以有效改善患者的负面情绪。
评估 PBC 治疗术后复发性 TN 的临床疗效，并分析焦虑、抑郁和睡眠障碍等情况的改善。
回顾性研究。
郑州大学第一附属医院麻醉与围术期医学中心疼痛科。
回顾性分析 2017 年 8 月至 2019 年 6 月期间接受 PBC 治疗的 121 例术后复发性 TN 患者的临床资料。采用巴罗神经研究所疼痛强度（BNI-P）评分来衡量疼痛的严重程度。采用医院焦虑抑郁量表（HADS）和匹兹堡睡眠质量指数（PSQI）评估焦虑、抑郁和睡眠状况。
术后第 1 天，104 例（86.0%）患者报告无痛，9 例（7.4%）患者偶尔疼痛但无需药物治疗，8 例（6.6%）患者疼痛无明显缓解。总有效率为 93.4%。此外，3 例（2.5%）患者在术后 2 周报告明显缓解。在 12 个月的随访期间，101 例（83.5%）患者保持无痛，5 例（4.1%）患者复发。考虑到经济因素，患者对药物治疗后的疼痛耐受，未进行重复 PBC。术前 46 例（38.0%）患者有焦虑，70 例（57.9%）患者有抑郁，62 例（51.2%）患者睡眠质量差。与术前相比，术后焦虑、抑郁和睡眠状况均有显著改善。术后不良反应包括 115 例（95.0%）患者面部麻木，86 例（71.1%）患者咀嚼肌无力，18 例（14.9%）患者单纯疱疹，2 例（1.7%）患者因展神经麻痹导致复视。本研究中无患者出现角膜感觉减退、痛觉过敏、无菌性脑膜炎、脑脊液漏、蛛网膜下腔出血、颈动脉海绵窦瘘或死亡。
本研究为单中心回顾性研究，样本量较小，随访时间相对较短。因此，PBC 治疗术后复发性 TN 的长期疗效需要进一步从多个中心、大样本量和长期随访进行评估。
PBC 是一种微创、安全、有效的治疗方法。此外，它明显改善了 TN 引起的焦虑、抑郁和睡眠质量症状，因此似乎可以作为手术治疗后复发性 TN 患者的优化选择。
