Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
Pain Physician. 2024 Jan;27(1):E79-E88.
Several studies have suggested favorable results with endoscope-assisted microvascular decompression (EA-MVD) for treating patients with trigeminal neuralgia (TN); however, supporting evidence is limited.
This study aimed to compare the efficacy and safety of EA-MVD with microscopic microvascular decompression (M-MVD).
Prospective controlled study.
We performed a prospective controlled clinical study that included 52 patients with TN (36, [69.2%] women; 16, [30.8%] men), from June 2021 through January 2022.
Patients were assigned to receive either EA-MVD (n = 23) or M-MVD (n = 29). The primary outcome was pain intensity relief, measured using the Visual Analog Scale (VAS) and the Barrow Neurological Institute grading scale. The secondary outcomes were the detection of multiple offending vessels, endoscopic use, operation time, hospital stay length, and complications. All patients were followed-up for >= 12 months.
At 12 months, both treatment groups showed similar improvements in pain intensity (P = 0.099). The mean VAS score was 3.5 ± 1.6 and 2.9 ± 1.7 in the EA-MVD and M-MVD groups, respectively. Overall, most patients in both groups reached a pain-free status or had nearly pain-free relief (EA-MVD: 21/23, 91.3%; M-MVD: 27/29, 93.1%). The incidence of multiple offending vessels was higher in the EA-MVD group than in the M-MVD group (52.2% vs 17.2%, P = 0.038). The mean operating time in the EA-MVD group (158 ± 27 minutes) was longer and the hospital stay (6 ± 1 days) was shorter than those of the M-MVD group (144 ± 25 minutes and 8 ± 4 days). No mortality or endoscope-related serious adverse events were noted, with the exception of an intracranial infection case in the M-MVD group.
The mean follow-up time was relatively short and a single-center study and a small patient population, which might bring some clinical bias.
M-MVD and EA-MVD achieved similar analgesic effects for TN; however, EA-MVD allowed observation of more probable offending vessels with good flexible operative visualization.
多项研究表明内镜辅助微血管减压术（EA-MVD）治疗三叉神经痛（TN）效果良好，但支持证据有限。
本研究旨在比较 EA-MVD 与显微镜下微血管减压术（M-MVD）的疗效和安全性。
前瞻性对照研究。
我们进行了一项前瞻性对照临床研究，纳入了 2021 年 6 月至 2022 年 1 月期间的 52 例 TN 患者（女性 36 例，占 69.2%；男性 16 例，占 30.8%）。
患者被分为 EA-MVD 组（n = 23）或 M-MVD 组（n = 29）。主要结局是使用视觉模拟量表（VAS）和巴罗神经研究所分级量表评估疼痛强度缓解情况。次要结局是检测到多个致病血管、内镜使用、手术时间、住院时间长度和并发症。所有患者均随访>=12 个月。
在 12 个月时，两组治疗组的疼痛强度均有类似的改善（P = 0.099）。EA-MVD 组和 M-MVD 组的平均 VAS 评分为 3.5 ± 1.6 和 2.9 ± 1.7。总体而言，两组大多数患者达到无痛或接近无痛缓解状态（EA-MVD：21/23，91.3%；M-MVD：27/29，93.1%）。EA-MVD 组的多发病变血管发生率高于 M-MVD 组（52.2% vs 17.2%，P = 0.038）。EA-MVD 组的平均手术时间（158 ± 27 分钟）较长，住院时间（6 ± 1 天）较短，而 M-MVD 组的平均手术时间（144 ± 25 分钟）和住院时间（8 ± 4 天）较短。除 M-MVD 组的一例颅内感染病例外，无死亡或内镜相关严重不良事件发生。
平均随访时间相对较短，且为单中心研究和小样本量，可能带来一定的临床偏倚。
M-MVD 和 EA-MVD 对 TN 均有相似的镇痛效果，但 EA-MVD 可观察到更多可能的致病血管，具有良好的灵活手术可视化效果。
