1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and.
2Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
J Neurosurg. 2023 Oct 20;140(4):1155-1159. doi: 10.3171/2023.8.JNS231345. Print 2024 Apr 1.
Microvascular decompression (MVD) is an effective intervention in patients with trigeminal neuralgia (TN). How prior rhizotomy can impact long-term pain outcomes following MVD is not well understood. In this study, the authors sought to compare pain outcomes in patients who had undergone primary MVD versus those who had undergone secondary MVD after a single or multiple rhizotomies.
The authors retrospectively reviewed the data on all patients who had undergone MVD at their institution from 2007 to 2020. Patients were included in the study if they had undergone primary MVD or if their surgical history was notable for past rhizotomy. Barrow Neurological Institute (BNI) pain scores were assigned at preoperative and final follow-up appointments. Perioperative complications were noted for each patient, and evidence of pain recurrence was recorded as well. A history of rhizotomy as well as other variables that might influence TN pain recurrence were evaluated using a Cox proportional hazards model. The impact of prior rhizotomy on TN pain recurrence following MVD was further assessed using Kaplan-Meier survival analysis.
Of 1044 patients reviewed, 947 met the study inclusion criteria. Of these, 796 patients had undergone primary MVD, 84 had a history of a single rhizotomy before MVD, and 67 had a history of ≥ 2 rhizotomies prior to MVD. Patients in the single rhizotomy and multiple rhizotomies cohorts exhibited a greater frequency of preoperative numbness (p < 0.001), higher preoperative BNI pain scores (p < 0.005), and higher rates of postoperative numbness (p = 0.04). However, final follow-up BNI pain scores were not significantly different between the primary MVD and prior rhizotomy groups (p = 0.34). Cox proportional hazards analysis revealed that younger age, multiple sclerosis, and female sex independently predicted an increased risk of pain recurrence following MVD. Neither a history of a single prior rhizotomy nor a history of multiple prior rhizotomies independently increased the risk of pain recurrence. Furthermore, Kaplan-Meier analysis of pain-free survival among the 3 groups revealed no relationship between a history of prior rhizotomy and pain recurrence following MVD (p = 0.57).
Percutaneous rhizotomy does not complicate outcomes following subsequent MVD for TN pain. However, patients undergoing rhizotomy before MVD may have an increased risk of postoperative facial numbness compared to that in patients undergoing primary MVD.
微血管减压术（MVD）是治疗三叉神经痛（TN）的有效干预措施。先前的神经根切断术如何影响 MVD 后的长期疼痛结果尚不清楚。在这项研究中，作者旨在比较初次 MVD 与单次或多次神经根切断术后行二次 MVD 的患者的疼痛结果。
作者回顾性分析了 2007 年至 2020 年在他们机构接受 MVD 的所有患者的数据。如果患者接受过初次 MVD 或手术史中有过去的神经根切断术，则将其纳入研究。在术前和最后随访时分配巴罗神经研究所（BNI）疼痛评分。记录每位患者的围手术期并发症，并记录疼痛复发的证据。评估了神经根切断术史以及可能影响 TN 疼痛复发的其他变量，使用 Cox 比例风险模型进行评估。进一步使用 Kaplan-Meier 生存分析评估先前的神经根切断术对 MVD 后 TN 疼痛复发的影响。
在审查的 1044 名患者中，947 名符合研究纳入标准。其中，796 名患者接受了初次 MVD，84 名患者在 MVD 前有单次神经根切断术史，67 名患者在 MVD 前有≥2 次神经根切断术史。单次神经根切断术和多次神经根切断术组的患者术前麻木的频率更高（p<0.001），术前 BNI 疼痛评分更高（p<0.005），术后麻木的发生率更高（p=0.04）。然而，初次 MVD 和先前神经根切断术组的最终随访 BNI 疼痛评分无显著差异（p=0.34）。Cox 比例风险分析显示，年龄较小、多发性硬化症和女性独立预测 MVD 后疼痛复发的风险增加。单次先前的神经根切断术史或多次先前的神经根切断术史均不能独立增加疼痛复发的风险。此外，对 3 组之间无疼痛生存的 Kaplan-Meier 分析显示，先前的神经根切断术史与 MVD 后疼痛复发之间无关系（p=0.57）。
经皮神经根切断术不会使随后的 MVD 治疗 TN 疼痛的结果复杂化。然而，与初次 MVD 相比，在 MVD 前接受神经根切断术的患者术后面部麻木的风险可能增加。
