Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Clin Neurol Neurosurg. 2024 Oct;245:108466. doi: 10.1016/j.clineuro.2024.108466. Epub 2024 Jul 22.
Patients undergoing percutaneous rhizotomy for trigeminal neuralgia (TN) may require several procedures to manage their pain. However, it is not fully understood whether repeat procedures influence postoperative complication rates.
We retrospectively reviewed patients undergoing rhizotomy at our institution from 2011 to 2022. Patients were included only if they had no history of prior interventions including microvascular decompression (MVD) or radiosurgery. We collected baseline patient information, pain characteristics, and postoperative complications for each patient. Patients were dichotomized into those undergoing primary rhizotomy versus those undergoing a repeat rhizotomy. Potential drivers of postoperative complications were included in a multivariate logistic regression model.
Of the 1904 cases reviewed, 965 met our inclusion criteria. 392 patients underwent primary rhizotomy, and 573 patients underwent repeat rhizotomies. The repeat rhizotomy group was significantly older, p<0.001. Patients in the repeat rhizotomy group expressed higher frequencies of bilateral pain, p=0.01. Patients in the repeat rhizotomy group demonstrated a significantly higher rate of preoperative numbness and postoperative numbness, p<0.001. There were no significant differences in any of the considered complications between the single rhizotomy and repeat rhizotomy groups. On multivariate logistic regression, repeat rhizotomy did not predict an increased risk of any postoperative complications, p=0.14.
Patients undergoing repeat rhizotomy may be at risk of postoperative numbness but are not at increased risk for postoperative complications. These results are of use to patients who are poor surgical candidates, and thus may require multiple rhizotomies to effectively manage their pain over time.
接受经皮脊神经根切断术（rhizotomy）治疗三叉神经痛（trigeminal neuralgia，TN）的患者可能需要多次手术来缓解疼痛。然而，目前尚不完全清楚重复手术是否会影响术后并发症的发生率。
我们回顾性分析了 2011 年至 2022 年在我院接受脊神经根切断术的患者。仅纳入无既往介入治疗史（包括微血管减压术[microvascular decompression，MVD]或放射外科手术）的患者。我们收集了每位患者的基线患者信息、疼痛特征和术后并发症。将患者分为初次脊神经根切断术组和重复脊神经根切断术组。将术后并发症的潜在驱动因素纳入多变量逻辑回归模型。
在回顾的 1904 例病例中，有 965 例符合纳入标准。392 例患者接受初次脊神经根切断术，573 例患者接受重复脊神经根切断术。重复脊神经根切断术组患者年龄显著更大（p<0.001）。重复脊神经根切断术组患者双侧疼痛频率更高（p=0.01）。重复脊神经根切断术组患者术前麻木和术后麻木发生率明显更高（p<0.001）。单次脊神经根切断术和重复脊神经根切断术组患者在任何考虑的并发症中均无显著差异。多变量逻辑回归分析显示，重复脊神经根切断术并不预示任何术后并发症的风险增加（p=0.14）。
接受重复脊神经根切断术的患者可能有术后麻木的风险，但发生术后并发症的风险并未增加。这些结果对于那些手术效果不佳、需要多次脊神经根切断术才能有效控制疼痛的患者有用。
