Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Oper Neurosurg (Hagerstown). 2023 Oct 1;25(4):353-358. doi: 10.1227/ons.0000000000000819. Epub 2023 Jul 11.
The influence of prior stereotactic radiosurgery (SRS) on outcomes of subsequent microvascular decompression (MVD) for patients with trigeminal neuralgia (TN) is not well understood. To directly compare pain outcomes in patients undergoing primary MVD vs those undergoing MVD with a history of 1 prior SRS procedure.
We retrospectively reviewed all patients undergoing MVD at our institution from 2007 to 2020. Patients were included if they underwent primary MVD or had a history of SRS alone before MVD. Barrow Neurological Institute (BNI) pain scores were assigned at preoperative and immediate postoperative time points and at every follow-up appointment. Evidence of pain recurrence was recorded and compared via Kaplan-Meier analysis. Multivariate Cox proportional hazards regression was used to identify factors associated with worse pain outcomes.
Of patients reviewed, 833 met our inclusion criteria. Thirty-seven patients were in the SRS alone before MVD group, and 796 patients were in the primary MVD group. Both groups demonstrated similar preoperative and immediate postoperative BNI pain scores. There were no significant differences between average BNI at final follow-up between the groups. Multiple sclerosis (hazard ratio (HR) = 1.95), age (HR = 0.99), and female sex (HR = 1.43) independently predicted increased likelihood of pain recurrence on Cox proportional hazards analysis. SRS alone before MVD did not predict increased likelihood of pain recurrence. Furthermore, Kaplan-Meier survival analysis demonstrated no relationship between a history of SRS alone and pain recurrence after MVD ( P = .58).
SRS is an effective intervention for TN that may not worsen outcomes for subsequent MVD in patients with TN.
立体定向放射外科（SRS）对随后行微血管减压术（MVD）治疗三叉神经痛（TN）患者结局的影响尚不清楚。本研究旨在直接比较初次行 MVD 与既往 SRS 后行 MVD 患者的疼痛结局。
我们回顾性分析了 2007 年至 2020 年期间在我院行 MVD 的所有患者。纳入标准为初次行 MVD 或既往 SRS 后行 MVD。患者在术前、术后即刻和每次随访时被分配 Barrow 神经研究所（BNI）疼痛评分。通过 Kaplan-Meier 分析记录和比较疼痛复发的证据。采用多变量 Cox 比例风险回归分析确定与较差疼痛结局相关的因素。
在回顾的患者中，833 例符合纳入标准。37 例患者在 MVD 前行 SRS 治疗，796 例患者行初次 MVD。两组患者的术前和术后即刻 BNI 疼痛评分相似。两组患者的最终随访时的平均 BNI 无显著差异。多灶性硬化症（危险比（HR）=1.95）、年龄（HR=0.99）和女性（HR=1.43）是 Cox 比例风险分析中疼痛复发的独立预测因素。MVD 前行 SRS 治疗与疼痛复发无关。此外，Kaplan-Meier 生存分析表明，MVD 前行 SRS 与 MVD 后疼痛复发之间无相关性（P=0.58）。
SRS 是 TN 的有效治疗方法，不会加重 TN 患者随后行 MVD 的结局。
