Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
Department of Neurosurgery, Da-Li Jan-Ai Hospital, Taichung, Taiwan, ROC.
J Chin Med Assoc. 2022 Feb 1;85(2):198-203. doi: 10.1097/JCMA.0000000000000667.
Trigeminal neuralgia (TN) is a disease characterized by recurring, short-lived, electric shock-like pain experienced on one side of the face. Microvascular decompression (MVD) is one of the most effective surgical interventions for resolving TN caused by neurovascular compression. This study aimed to determine the predictive and prognostic factors of surgical outcomes.
This retrospective cohort study enrolled patients diagnosed with TN who underwent MVD at our hospital during 2013-2019. The demographic information, pain character, peri-operative Barrow Neurological Institute (BNI) scale, medication, operative finding were recorded. And the outcome was Outcomes were divided into drug-free and drug-dependent group. Predisposing factors for each outcome were analyzed by one-way analysis of variance, followed by a Mann-Whitney U test or Kruskal-Wallis test.
A total of 104 consecutive patients received MVD to treat TN, and 88 patients were enrolled in this study. The overall postoperative drug-free outcome was 72.7%. A significant difference in drug-free outcomes was observed for patients with typical TN (80.8%) compared with patients with atypical TN (33.33%, p = 0001). When severe venous compression was encountered during MVD, the drug-free outcome fell to 50% (10/20, p = 0.009). The Mann-Whitney U test indicated typical TN as a positive predictive factor of a drug-free outcome, whereas severe venous compression was a negative predictive factor. The patients with preoperative BNI score of 4 had better improvement than others (p = 0.045). Age, onset duration, and arterial loop had no specific difference in this study.
In our study, atypical TN and severe venous compression were associated with poor outcomes. Regrouping atypical TN into precise diagnosis represents an immediate priority according to our result. The preoperative BNI score could be used as an effective predictive tool for the outcome of MVD surgery.
三叉神经痛（TN）是一种以面部单侧反复发作、短暂、电击样疼痛为特征的疾病。微血管减压术（MVD）是治疗由神经血管压迫引起的 TN 的最有效手术干预之一。本研究旨在确定手术结果的预测和预后因素。
这是一项回顾性队列研究，纳入了 2013 年至 2019 年在我院接受 MVD 治疗的 TN 患者。记录了患者的人口统计学信息、疼痛特征、围手术期巴罗神经研究所（BNI）量表、药物治疗和手术发现。并将结果分为无药物组和药物依赖组。通过单向方差分析对每种结果的易患因素进行分析，然后进行 Mann-Whitney U 检验或 Kruskal-Wallis 检验。
共有 104 例连续患者接受 MVD 治疗 TN，其中 88 例纳入本研究。术后无药物组的总体结果为 72.7%。典型 TN 患者（80.8%）与非典型 TN 患者（33.33%）的无药物结果差异有统计学意义（p=0.0001）。当 MVD 术中遇到严重静脉压迫时，无药物结果降至 50%（10/20，p=0.009）。Mann-Whitney U 检验表明，典型 TN 是无药物结果的阳性预测因素，而严重静脉压迫是阴性预测因素。术前 BNI 评分为 4 分的患者改善效果更好（p=0.045）。在本研究中，年龄、发病时间和动脉环没有特定的差异。
在我们的研究中，非典型 TN 和严重静脉压迫与不良结果相关。根据我们的结果，将非典型 TN 重新归类为精确诊断是当务之急。术前 BNI 评分可作为 MVD 手术结果的有效预测工具。
