Alasta Abdullah, Al Naggar Abdullah M, Al-Saidy Abdullah, Al Wesabi Fuad
Department of Neurosurgery, Modern European Hospital, Sana'a, YEM.
Department of Anesthesia, Al Thawra Modern General Hospital, Sana'a, YEM.
Cureus. 2025 Mar 28;17(3):e81362. doi: 10.7759/cureus.81362. eCollection 2025 Mar.
Background Trigeminal neuralgia (TN) is a rare and painful condition that offers various treatment options. Despite the availability of multiple modalities, their comparative efficacy is still debated due to inconsistent study outcomes. Microvascular decompression (MVD) using autologous muscle grafts has recently gained attention as a treatment option. While muscle grafts were previously employed extensively, this approach is only now being introduced in Yemen, where documented outcomes related to MVD for TN are scarce. This study aims to present the outcomes of MVD for TN utilizing autologous muscle grafts in a resource-limited environment. Patients and methods This study employs a retrospective cross-sectional design involving 324 patients diagnosed with TN who underwent MVD using autologous muscle grafts between April 1, 2006, and March 25, 2020. Data regarding demographic and clinical factors, outcomes, and complications were systematically collected and analyzed. Results The mean age of the patients was 48.8±11.6 years, with the majority being female patients (n=180, 55.6%), with a significant proportion of patients exhibiting left-sided involvement (n=204; 63%). Significant nerve compression was the primary operative finding in the study population (n=251; 77.5%). In most cases, a single vessel contributed to the compression of the nerve, primarily the superior cerebellar artery (n=303; 93.5%). No major surgical complications were reported, with temporary nasal cerebrospinal fluid (CSF) leakage (n=1; 0.3%), transient facial numbness (n=16; 4.9%) that resolved within one week to one month, hyperacusis (n=5; 1.5%), and hyperesthesia (n=3; 0.9%) being the common ones. Follow-up over an average of 52.7±8.0 months indicated that the majority of patients (n=302; 93.2%) achieved favorable outcomes, as reflected in Barrow Neurological Institute (BNI) scores I and II. The BNI pain intensity score improved from V preoperatively to I and II and was statistically significant (P=0.006). The remaining patients (n=22; 6.8%) exhibited fair to poor BNI scores (III, IV, and V). Sixteen patients obtained effective pain relief through medication, while six required radiofrequency thermocoagulation. Conclusion The findings suggest that MVD utilizing autologous muscle grafts may serve as an effective long-term surgical intervention for TN, even in resource-limited settings. Effective management of TN necessitates a comprehensive preoperative assessment, careful candidate selection, appropriate imaging techniques, and proficient surgical execution.
三叉神经痛（TN）是一种罕见的疼痛性疾病，有多种治疗选择。尽管有多种治疗方式，但由于研究结果不一致，它们的相对疗效仍存在争议。使用自体肌肉移植的微血管减压术（MVD）最近作为一种治疗选择受到关注。虽然肌肉移植以前被广泛应用，但这种方法直到现在才在也门引入，在也门，关于TN的MVD的记录结果很少。本研究旨在介绍在资源有限的环境中使用自体肌肉移植进行TN的MVD的结果。
本研究采用回顾性横断面设计，纳入了324例被诊断为TN的患者，这些患者在2006年4月1日至2020年3月25日期间接受了使用自体肌肉移植的MVD。系统收集并分析了有关人口统计学和临床因素、结果及并发症的数据。
患者的平均年龄为48.8±11.6岁，大多数为女性患者（n = 180，55.6%），相当一部分患者表现为左侧受累（n = 204；63%）。在研究人群中，主要手术发现为明显的神经受压（n = 251；77.5%）。在大多数情况下，单一血管导致神经受压，主要是小脑上动脉（n = 303；93.5%）。未报告重大手术并发症，常见的有暂时性鼻脑脊液漏（n = 1；0.3%）、在1周内至1个月内缓解的短暂性面部麻木（n = 16；4.9%）、听觉过敏（n = 5；1.5%）和感觉过敏（n = 3；0.9%）。平均随访52.7±8.0个月表明，大多数患者（n = 302；93.2%）取得了良好的结果，如巴罗神经学研究所（BNI）I级和II级评分所示。BNI疼痛强度评分从术前的V级改善为I级和II级，差异有统计学意义（P = 0.006）。其余患者（n = 22；6.8%）的BNI评分显示为一般至较差（III级、IV级和V级）。16例患者通过药物治疗获得了有效的疼痛缓解，而6例患者需要进行射频热凝治疗。
研究结果表明，即使在资源有限的环境中，使用自体肌肉移植的MVD也可能是TN有效的长期手术干预措施。TN的有效管理需要全面的术前评估、仔细的候选者选择、适当的成像技术和熟练的手术操作。
