Weng Jiancong, Liu Jiang, Zhang Ziyi, Li Mingxiao, Zhang Yulian, Wang Quancai, Zhen Xueke, Xu Xiaoli, Zhang Li, Yuan Yue, Yu Yanbing
Department of Neurosurgery, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing, 100029, China.
Peking Union Medical College, Beijing, China.
Neurosurg Rev. 2025 May 8;48(1):407. doi: 10.1007/s10143-025-03559-1.
Recurrent Trigeminal Neuralgia (TN) poses significant challenges for treatment, often necessitating repeated Microvascular Decompression (MVD). This study aims to evaluate the safety, efficacy, and prognostic factors associated with repeated MVD for recurrent TN at our institution. A retrospective review was conducted on 147 patients who underwent repeated MVD between September 2010 and September 2023. Data on surgical procedures, postoperative outcomes, and recurrence rates were collected. The primary endpoint was recurrent pain. Univariate and multivariate Cox proportional hazards analyses were used to identify predictors of pain recurrence. In this cohort, 147 patients underwent revision surgery, comprising 97 females and 50 males. The primary reason for the nonresolution in 96 patients was adhesions of Teflon pledgets to the trigeminal nerve, while in 51 patients, previously missed vascular compression was identified. After a median follow-up of 53.3 months, 14 patients were lost to follow-up. Twelve patients (9.0%) reported no pain relief after repeated MVD, while 121 patients (91.0%) achieved complete pain relief. The most common complication was facial numbness, occurring in 101 cases (68.7%), followed by blurred vision (11 patients, 7.5%), hearing impairment (8 patients, 5.4%), poor wound healing (2 patients, 1.4%), postoperative stroke confirmed by CT imaging (2 patients, 1.4%) and permanent ataxia (2 patients, 1.4%). The mortality rate for repeated MVD at our center was zero. Twenty-four patients (19.8%) experienced pain recurrence, with a median pain-free survival (PFS) of 36.0 months. The 5- and 10-year PFS rates were 80.8% and 54.5%, respectively. Patients who underwent combined partial sensory rhizotomy (PSR) and MVD (Hazard Ratio [HR] 0.203, 95% Confidence Interval [CI] 0.047-0.882, p = 0.033) or circumferential dissection and MVD (HR 0.295, 95% CI 0.099-0.882, p = 0.029) had lower recurrence rates compared to MVD alone. Long-term facial numbness was the most common complication, particularly in patients undergoing PSR. Repeated MVD is effective and safe for recurrent TN. PSR with MVD is associated with lower rate of TN recurrence but increases the risk of facial numbness. Conversely, circumferential dissection is associated with lower recurrence rates without increasing postoperative facial numbness.
Not applicable.
复发性三叉神经痛（TN）的治疗面临重大挑战，常常需要反复进行微血管减压术（MVD）。本研究旨在评估在我们机构中，针对复发性TN进行反复MVD的安全性、有效性及预后因素。对2010年9月至2023年9月期间接受反复MVD的147例患者进行了回顾性研究。收集了手术过程、术后结果及复发率的数据。主要终点为疼痛复发。采用单因素和多因素Cox比例风险分析来确定疼痛复发的预测因素。在该队列中，147例患者接受了翻修手术，其中女性97例，男性50例。96例患者治疗未缓解的主要原因是聚四氟乙烯棉片与三叉神经粘连，而51例患者发现存在先前遗漏的血管压迫。中位随访53.3个月后，14例患者失访。12例患者（9.0%）在反复MVD后疼痛未缓解，而121例患者（91.0%）实现了完全疼痛缓解。最常见的并发症是面部麻木，共101例（68.7%），其次是视力模糊（11例患者，7.5%）、听力障碍（8例患者，5.4%）、伤口愈合不良（2例患者，1.4%）、CT成像证实的术后卒中（2例患者，1.4%）和永久性共济失调（2例患者，1.4%）。我们中心反复MVD的死亡率为零。24例患者（19.8%）出现疼痛复发，中位无疼痛生存期（PFS）为36.0个月。5年和10年PFS率分别为80.8%和54.5%。接受联合部分感觉神经根切断术（PSR）和MVD（风险比[HR]0.203，95%置信区间[CI]0.047 - 0.882，p = 0.033）或环周分离和MVD（HR 0.295，95% CI 0.099 - 0.882，p = 0.029）的患者与单纯MVD相比复发率更低。长期面部麻木是最常见的并发症，尤其在接受PSR的患者中。反复MVD对于复发性TN是有效且安全的。PSR联合MVD与较低的TN复发率相关，但增加了面部麻木的风险。相反，环周分离与较低的复发率相关且不增加术后面部麻木。
不适用。
