Barker F G, Jannetta P J, Bissonette D J, Jho H D
Neurosurgical Service, Massachusetts General Hospital, Boston, USA.
Neurosurgery. 1997 Jan;40(1):39-45. doi: 10.1097/00006123-199701000-00008.
After most operative treatments for trigeminal neuralgia, long-term tic relief is closely correlated with postoperative numbness in the trigeminal distribution. Microvascular decompression (MVD) is proposed to relieve tic through a nontraumatic mechanism. We investigated the relationship between postoperative trigeminal numbness and tic relief in a large, prospectively followed cohort of patients treated with MVD for typical trigeminal neuralgia.
Of 1204 patients who underwent MVD for typical tic during a 20-year period, 522 had single MVDs on a single side, had not undergone ablative trigeminal procedures before or after MVD, and were still being followed in 1994. In 1994, patients graded facial numbness using a questionnaire (response rate, 92%) with a 5-point scale. Multivariate Cox and logistic regression methods were used. The analyses were adjusted for the time that had passed between the performance of MVD and the completion of the questionnaire (minimum, 2 yr).
Seventeen percent of patients reported some degree of persistent facial numbness. Decompression of a vein at MVD (odds ratio, 2.5) and failure to find compression by the superior cerebellar artery (odds ratio, 2.0) independently predicted postoperative facial numbness, which in turn predicted postoperative burning and aching facial pain (odds ratio, 5.2-5.9). A trend toward worse outcome was noted in patients with numb faces (P = 0.3). Similar findings were noted in subgroups of patients in whom the superior cerebellar artery was decompressed at MVD (n = 381) and in whom a superior cerebellar artery with no vein was found (n = 120). In the latter subgroup, facial numbness (5.8% of patients) significantly predicted worse long-term outcome (P = 0.03).
We found no evidence that postoperative trigeminal numbness predicts relief of typical tic after MVD. Trigeminal numbness was related to operative findings at MVD and predicted postoperative burning and aching facial pain. To minimize postoperative facial dysesthesia, trauma to the trigeminal root during MVD should be avoided when possible.
在大多数三叉神经痛手术治疗后，长期抽搐缓解与三叉神经分布区术后麻木密切相关。微血管减压术（MVD）被认为是通过非创伤性机制缓解抽搐。我们在一个大型的、前瞻性随访的接受MVD治疗典型三叉神经痛的患者队列中，研究了术后三叉神经麻木与抽搐缓解之间的关系。
在20年期间接受MVD治疗典型抽搐的1204例患者中，522例接受了单侧单次MVD，在MVD之前或之后未接受过三叉神经毁损手术，并且在1994年仍在接受随访。1994年，患者使用一份问卷（回复率为92%）以5分制对面部麻木进行评分。使用多变量Cox和逻辑回归方法。分析针对MVD实施与问卷完成之间经过的时间（最短2年）进行了校正。
17%的患者报告有一定程度的持续性面部麻木。MVD时对静脉进行减压（比值比，2.5）以及未发现小脑上动脉压迫（比值比，2.0）独立预测术后面部麻木，而术后面部麻木又预测术后面部灼痛和刺痛（比值比，5.2 - 5.9）。面部麻木的患者有预后较差的趋势（P = 0.3）。在MVD时对小脑上动脉进行减压的患者亚组（n = 381）以及未发现有静脉的小脑上动脉的患者亚组（n = 120）中也观察到类似结果。在后一个亚组中，面部麻木（5.8%的患者）显著预测了更差的长期预后（P = 0.03）。
我们没有发现证据表明术后三叉神经麻木可预测MVD后典型抽搐的缓解。三叉神经麻木与MVD时的手术发现有关，并可预测术后面部灼痛和刺痛。为使术后面部感觉异常最小化，MVD期间应尽可能避免对三叉神经根造成损伤。
