原发性三叉神经痛（PTN）的完全神经内镜下显微镜下三叉神经微血管减压术（MVD）
Complete neuroendoscopic microscopical trigeminal neuralgia microvascular decompression (MVD) in primary trigeminal neuralgia (PTN).
作者信息
Wang Peng, Li Qing, Wang Chunsheng, Li Chunhui
机构信息
Neurosurgery Department, The Affiliated Hospital of Hebei University Baoding 071000, Hebei Province, China.
Neurosurgery Department, Baoding No. 1 Hospital Baoding 071000, Hebei Province, China.
出版信息
Am J Transl Res. 2021 Nov 15;13(11):12905-12912. eCollection 2021.
OBJECTIVE
To compare complete neuroendoscopic and microscopic microvascular decompression (MVD) in primary trigeminal neuralgia (PTN) and their impacts on the microstructure of the trigeminal nerve.
METHODS
Eighty-seven PTN patients admitted in our hospital from July 2017 to December 2019 were selected for this prospective study and divided into the endoscopic group (n=45) (complete neuroendoscopic MVD) and the microscope group (n=42) (microscopic MVD) according to the treatment method each patient underwent. All the patients underwent MRI scanning, and the fractional anisotropy (FA) scores and the apparent diffusion coefficient (ADC) values of the neurovascular compression (NVC) sites were measured. The operation times, the treatment efficacy, the microstructural changes in the trigeminal nerve, the complications, and the recurrence and mortality rates at one year after the operations were compared.
RESULTS
The endoscopic group observed a superior therapeutic effect compared with the microscope group one year after the surgeries (P=0.046). After the surgeries, the endoscopic group observed a greater increase in their FA values and a larger decline in their ADC values than the microscope group did (P=0.014, 0.015, 0.011, 0.002). The complication rate in the endoscopic group was 11.11%, and the complication rate in the microscopic group was 30.95% (P=0.022). One year after the surgeries, we found a lower recurrence rate in the endoscopic group (P=0.001). The perforator vessels from the offending vessel to the outlet area of the durmedulla, the distances between the front edge of the bone window and the inner surfaces of the petrous part of the temporal bone ≥ the distance between the duration ≥ the duration of conventional MVD were independent risk factors for complications after MVD in the hemifacial spasm patients (P=0.001, 0.037, 0.023, 0.005).
CONCLUSION
Complete neuroendoscopic MV yields better long-term treatment outcomes than microscopic MVD, and it is more effective at improving the microstructure of the trigeminal nerve and has fewer postoperative complications.
目的
比较原发性三叉神经痛（PTN）患者接受完全神经内镜下和显微镜下微血管减压术（MVD）的效果及其对三叉神经微观结构的影响。
方法
选取2017年7月至2019年12月在我院收治的87例PTN患者进行这项前瞻性研究，根据每位患者接受的治疗方法分为内镜组（n = 45）（完全神经内镜下MVD）和显微镜组（n = 42）（显微镜下MVD）。所有患者均接受MRI扫描，测量神经血管压迫（NVC）部位的分数各向异性（FA）评分和表观扩散系数（ADC）值。比较手术时间、治疗效果、三叉神经微观结构变化、并发症以及术后一年的复发率和死亡率。
结果
术后一年，内镜组的治疗效果优于显微镜组（P = 0.046）。术后，内镜组的FA值升高幅度和ADC值下降幅度均大于显微镜组（P = 0.014、0.015、0.011、0.002）。内镜组的并发症发生率为11.11%，显微镜组为30.95%（P = 0.022）。术后一年，内镜组的复发率较低（P = 0.001）。责任血管至硬脑膜髓质出口区域的穿支血管、骨窗前缘与颞骨岩部内表面之间的距离≥传统MVD持续时间是面肌痉挛患者MVD术后并发症的独立危险因素（P = 0.001、0.037、0.023、0.005）。
结论
完全神经内镜下MVD的长期治疗效果优于显微镜下MVD，在改善三叉神经微观结构方面更有效，且术后并发症更少。
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