Martinelli Renata, Burattini Benedetta, D'Ercole Manuela, D' Alessandris Giorgio Quintino, Izzo Alessandro, Montano Nicola
Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS- Università Cattolica del Sacro Cuore, Rome, Italy.
Neurosurg Rev. 2025 Jul 16;48(1):569. doi: 10.1007/s10143-025-03715-7.
The aim of the present study was to conduct a systematic review on the role of intraoperative neuro-monitoring (IONM) in microvascular decompression (MVD) surgery for patients affected by trigeminal neuralgia (TN) specifically regarding its impact on clinical outcomes and whether its use may aid in identifying the site of neurovascular conflict (NVC). We reviewed the literature following PRISMA guidelines to identify and critically assess relevant studies. The review question was formulated according to the PICO framework as follows: "For patients affected by TN undergoing MVD (P), does IONM (I), compared to surgery without neuromonitoring (C), correlate with clinical outcomes? Moreover, can IONM be useful in identifying the NVC (O) site?". The literature search yielded a total of 504 results. After removing duplicates (n = 187), 317 papers were screened. Following title and abstract screening, 307 records were excluded. Ultimately, 10 studies were deemed relevant to the research purpose. IONM plays a significant role in MVD for TN, improving surgical precision, enhancing patient safety, and providing real-time prognostic insights. The included studies have demonstrated its utility in preventing complications and identifying the culprit vessel responsible for NVC during MVD.To the best of our knowledge, this is the first systematic review highlighting the role of IONM in MVD performed for TN and its impact on postoperative clinical outcomes and the intraoperative identification of the NVC. Further prospective studies are needed to standardize IONM protocols and refine its application in MVD, ensuring personalized treatment even in complex cases.
本研究的目的是对术中神经监测（IONM）在三叉神经痛（TN）患者微血管减压术（MVD）中的作用进行系统评价，具体涉及其对临床结局的影响以及其使用是否有助于确定神经血管冲突（NVC）的部位。我们按照PRISMA指南对文献进行了回顾，以识别并严格评估相关研究。根据PICO框架，将综述问题表述如下：“对于接受MVD的TN患者（P），与未进行神经监测的手术（C）相比，IONM（I）是否与临床结局相关？此外，IONM在确定NVC（O）部位方面是否有用？”文献检索共获得504条结果。去除重复项（n = 187）后，筛选了317篇论文。经过标题和摘要筛选，排除了307条记录。最终，10项研究被认为与研究目的相关。IONM在TN的MVD中发挥着重要作用，提高了手术精度，增强了患者安全性，并提供了实时预后见解。纳入的研究已证明其在预防并发症以及在MVD期间识别导致NVC的责任血管方面的效用。据我们所知，这是第一项系统评价，突出了IONM在为TN进行的MVD中的作用及其对术后临床结局和术中NVC识别的影响。需要进一步的前瞻性研究来规范IONM方案并完善其在MVD中的应用，即使在复杂病例中也能确保个性化治疗。
