The First Clinical Medical College of Gannan Medical University, Ganzhou, China; Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
Medical College of Nanchang University, Nanchang, China; Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
World Neurosurg. 2024 Oct;190:e212-e222. doi: 10.1016/j.wneu.2024.07.094. Epub 2024 Jul 18.
To compare whether there is a difference in the efficacy of complete endoscopic microvascular decompression (EVD) and microscopic microvascular decompression (MVD) in patients with classical trigeminal neuralgia (CTN).
From January 2014 to January 2021, 297 CTN patients were assigned to the retrosigmoid approach EVD (138 cases) and the MVD groups (159 cases); to compare whether there are differences in the pain control rate, recurrence, complications of CTN patients between the 2operations, and separately predict the factors related to prognosis of both groups.
There was no significant difference in painless rates at 1, 3, and 5 years after surgery (P = 0.356, P = 0.853, P = 1), and overall incidence of complications (P = 0.058) between the EVD and MVD groups. The EVD group had shorter surgical decompression duration than the MVD group (P < 0.001). The painless rate of patients with vertebrobasilar trigeminal neuralgia in the EVD group was higher than that in the MVD group, but the difference was not statistically significant (90% vs. 61.1%, P = 0.058). The independent risk factors associated with a good prognosis in the EVD group were a shorter course of the disease and severe neurovascular conflict, while severe neurovascular conflict is the only independent risk factor associated with a good prognosis in the MVD group.
For CTN patients, compared with traditional MVD, EVD is also safe and effective and has the advantage of shorter decompression time.The predictive results of prognostic factors also suggest that CTN patients may benefit more from early surgical treatment.
比较经典三叉神经痛（CTN）患者完全内镜下微血管减压术（EVD）与显微镜下微血管减压术（MVD）的疗效差异。
回顾性分析 2014 年 1 月至 2021 年 1 月收治的 297 例 CTN 患者，分别采用乙状窦后入路 EVD（138 例）和 MVD（159 例）。比较两种手术方式治疗 CTN 患者的疼痛控制率、复发率、并发症的差异，分别预测两组患者预后的相关因素。
EVD 组和 MVD 组术后 1、3、5 年无痛率差异均无统计学意义（P=0.356，P=0.853，P=1），总并发症发生率（P=0.058）差异亦无统计学意义。EVD 组手术减压时间短于 MVD 组（P<0.001）。EVD 组椎基底动脉三叉神经痛患者的无痛率高于 MVD 组，但差异无统计学意义（90% vs. 61.1%，P=0.058）。EVD 组预后良好的独立危险因素为病程较短和严重的神经血管冲突，而 MVD 组预后良好的独立危险因素仅为严重的神经血管冲突。
对于 CTN 患者，与传统 MVD 相比，EVD 同样安全有效，且具有减压时间短的优势。预后因素的预测结果也提示 CTN 患者可能从早期手术治疗中获益更多。
