Zhang Zihao, Hao Qingpei, Wu Gang, Ouyang Jia, Zheng Wentao, Zhou Haoqi, Liu Yezu, Miao Zeyu, Qin Guangbiao, Liu Ruen
Department of Neurosurgery, Peking University People's Hospital, Beijing, China.
Department of Neurosurgery, Peking University People's Hospital, Beijing, China; Functional Neurosurgery Research Center, Peking University Health Science Center, Beijing, China.
World Neurosurg. 2024 Nov;191:e489-e495. doi: 10.1016/j.wneu.2024.08.157. Epub 2024 Sep 5.
This study aimed to investigate the predictive factors associated with the reactivation of herpes simplex virus (HSV) in patients with trigeminal neuralgia after surgery and to determine whether there is a correlation between reactivation and surgical efficacy.
This study included 190 patients who underwent surgery between January 2020 and December 2021. Postoperative HSV reactivation was defined as the presence of perioral or gingival herpes and herpes labialis within 1 week postoperatively. Logistic regression analysis was used to evaluate clinical characteristics as potential predictors of HSV reactivation. Additionally, Spearman's rank correlation coefficient was used to determine any correlation between the postoperative Barrow Neurological Institute pain intensity score and HSV reactivation.
Of the 190 patients, 56 (29.5%) experienced postoperative HSV reactivation. Both univariate and multivariate analyses identified several significant predictors of HSV reactivation, such as a history of HSV infection, previous trigeminal nerve-damaging surgery, the use of internal neurolysis as a surgical technique, and an operation time of ≥25 minutes. No significant correlation was found between HSV reactivation and pain relief, as measured by Barrow Neurological Institute scores.
HSV reactivation was observed in a considerable proportion of patients with trigeminal neuralgia. Long operative times (≥25 minutes), the use of internal neurolysis as a surgical technique, a history of HSV infection, and previous trigeminal nerve-damaging surgery were identified as risk factors. Further research is needed to optimize surgical procedures and develop targeted management protocols to reduce the risk of HSV reactivation.
本研究旨在探讨三叉神经痛患者术后单纯疱疹病毒（HSV）再激活的相关预测因素，并确定再激活与手术疗效之间是否存在相关性。
本研究纳入了2020年1月至2021年12月期间接受手术的190例患者。术后HSV再激活定义为术后1周内出现口周或牙龈疱疹及唇疱疹。采用逻辑回归分析评估临床特征作为HSV再激活的潜在预测因素。此外，使用Spearman等级相关系数确定术后巴罗神经学研究所疼痛强度评分与HSV再激活之间的相关性。
190例患者中，56例（29.5%）出现术后HSV再激活。单因素和多因素分析均确定了HSV再激活的几个重要预测因素，如HSV感染史、既往三叉神经损伤手术、采用内部分解术作为手术技术以及手术时间≥25分钟。根据巴罗神经学研究所评分，未发现HSV再激活与疼痛缓解之间存在显著相关性。
相当一部分三叉神经痛患者出现了HSV再激活。手术时间长（≥25分钟）、采用内部分解术作为手术技术、HSV感染史以及既往三叉神经损伤手术被确定为危险因素。需要进一步研究以优化手术程序并制定针对性的管理方案，以降低HSV再激活的风险。
