目的:在三叉神经和侵犯动脉之间进行手术插入材料,以手术治疗耐药三叉神经痛(TGN),在Jannetta方法之后,已被证明是最成功的侵入性治疗。对TGN复发的患者的重新检查发现,由于介入材料引起的神经根刺激和疤痕形成。为了防止这些并发症,微血管减压术(MVD)的改良旨在使血管远离三叉神经,没有额外的材料附着到神经根。鉴于这两种技术(插入和换位)都已在作者机构中进行,他们决定分析短期和中期结果。
方法:回顾性分析2008年至2022年在作者机构接受耐药TGNMVD的所有患者。使用BarrowNeurologicalInstitute疼痛强度评分评估出院和随访时的结果。此外,评估并发症和疼痛复发.
结果:共有114例患者采用转位手术,110例患者采用间位手术治疗。对于转位102例患者,中位随访时间为31.5个月,对于介入治疗,100例患者接受了中位随访时间为95个月.在出院时,转位和间位组的患者分别为92.1%和94.5%,分别,经历了良好的结果(巴罗神经研究所疼痛强度评分I-III)。在后续行动中,83.3%和85%的患者在转位和间位组,分别,继续表现出良好的结果。在换位组中4.9%的患者和在插入组中6%的患者中,疼痛复发。在转位组中,有24.6%的患者发生并发症,在插入组中,有27.3%的患者发生并发症。最常见的并发症是面部感觉过度(10.5%vs11.8%,换位vs插入),其次是脑脊液渗漏(2.6%vs8.2%)。
结论:MVD转位是解决小脑桥脑角血管神经冲突的一种优雅方法。类似于插播,转位显示耐药TGN患者的短期和中期预后阳性.然而,换位的主要目标,这是改善预防复发和减少三叉神经并发症,在这项研究中无法证实。
OBJECTIVE: Operative interposition of material between the trigeminal nerve and offending artery for surgical treatment of drug-resistant trigeminal neuralgia (TGN), following the Jannetta method, has been proven to be the most successful invasive treatment. Reexplorations of patients with recurrence of TGN have revealed nerve root irritations and scarring due to interposed material. To prevent these complications, modifications of microvascular decompression (MVD) aim at transposing the vessel away from the trigeminal nerve, without attachment of additional material to the nerve root. Given that both techniques (interposition and transposition) have been performed in the authors\' institution, they decided to analyze them for the short- and midterm outcomes.
METHODS: All patients who had undergone MVD for drug-resistant TGN in the authors\' institution between 2008 and 2022 were analyzed retrospectively. Outcome at discharge and follow-up was evaluated using the Barrow Neurological Institute pain intensity score. Additionally, complications and pain recurrence were assessed.
RESULTS: A total of 114 patients were operated on using
transposition and 110 patients were treated using interposition. For
transposition 102 patients were followed up for a median of 31.5 months, and for interposition 100 patients were followed up for a median of 95 months. At discharge 92.1% versus 94.5% of patients in the transposition and interposition groups, respectively, experienced a good outcome (Barrow Neurological Institute pain intensity scores I-III). At follow-up, 83.3% versus 85% of patients in the
transposition and interposition groups, respectively, continued to demonstrate a good outcome. In 4.9% of patients in the transposition group and in 6% of patients in the interposition group, recurrence of pain occurred. Complications occurred in 24.6% of patients in the transposition and in 27.3% of those in the interposition group. The most frequent complications were facial hypesthesia (10.5% vs 11.8%, transposition vs interposition), followed by CSF leaks (2.6% vs 8.2%).
CONCLUSIONS: Transposition for MVD is an elegant way of solving vessel-nerve conflicts at the cerebellopontine angle. Similar to interposition, transposition shows positive short- and midterm outcomes for patients experiencing drug-resistant TGN. However, the main objective of transposition, which is improved prevention of recurrence and reduction of complications at the trigeminal nerve, could not be confirmed in this
study.