A Clinical Study Of Microvascular Decompression And Percutaneous Balloon Compression In The Treatment Of Trigeminal Neuralgia

Clinical study of different balloon pressure on the efficacy and complications of percutaneous balloon compression in the treatment of trigeminal neuralgiaObjective: Percutaneous balloon compression(PBC)is regarded as a good surgical treatment of trigeminal neuralgia.There are few studies about the balloon pressure.In this study,we aim to explore the clinical outcomes and complications of patients with primary trigeminal neuralgia under different balloon pressure.Methods: Patients with primary trigeminal neuralgia who underwent PBC in Nanjing drum tower hospital from July 2018 to March 2019 were studied in this prospective clinical research.They were randomly divided into three groups: Group 1,with intraoperative balloon pressure of 150 k Pa;Group 2,with intraoperative balloon pressure of 170 k Pa;Group 3,with intraoperative balloon pressure of 200 k Pa.All patients were followed up for at least 2 years.The clinical characteristics,surgical outcomes and complications were analyzed.Results: By March 2021,116 patients were followed up for at least 2 years.There was no significant difference in age,preoperative duration,gender,side,involved branches,hypertension or diabetes,previous MVD operation history or preoperative pain grading among the three groups(P > 0.05).Postoperative pain grading was significantly different with preoperative pain grading in each group(P=0.000,P=0.000,P=0.000).There was no significant difference in postoperative pain grading among the three groups(P > 0.05).The two-year recurrence rate was significantly different in the 3 groups(P=0.032),and balloon pressure had a negative correlation with it(r =-0.241,P = 0.009).Logistic regression analysis indicated that balloon pressure,preoperative duration and diabetes are related factors of recurrence(P=0.032,P=0.000,P=0.005).There was significant difference in numbness grading between the three groups immediately after operation and half a year after operation(P=0.001,P=0.000).Balloon pressure had a positive correlation with numbness grading immediately after operation and half a year after operation(r=0.349,P=0.000;r=0.329,P=0.000).After one year,Numbness degree among the three groups showed no significant difference(P > 0.05).There was statistical difference among the three groups in masticatory muscle weakness(P=0.006).The balloon pressure had a positive correlation with masticatory muscle weakness(r=0.297,P=0.001).Conclusion: 1.PBC has a good clinical effect in the treatment of trigeminal neuralgia,and there is no significant difference in the immediate outcome after surgery under the pressure of 150 k Pa,170 k Pa or 200 k Pa.2.When the balloon pressure is higher,the 2-year postoperative painless rate is higher,and the recurrence rate is lower.3.When the balloon pressure was high,the degree of postoperative numbness was more severe in half a year.The grading of facial numbness was not significantly related to the balloon pressure one year later after PBC.4.Higher balloon pressure is related to higher rate of masticatory muscle weakness.5.For patients with trigeminal neuralgia undergoing PBC surgery,balloon pressure should be selected individually to improve patient’s life quality.The classification and protective strategies of superior petrosal vein in micorvascular decompression for trigeminal neuralgiaObjective: In addition to percutaneous balloon compression(PBC),microvascular decompression(MVD)is effective in the treatment of trigeminal neuralgia.The management of superior petrosal vein(SPV)during MVD is very important.This study was to explore the classification and surgical strategy of superior petrosal vein in MVD for trigeminal neuralgia.Methods: The patients with primary trigeminal neuralgia who underwent MVD in the department of neurosurgery,Nanjing drum tower hospital from July 2018 to April 2019 were analyzed retrospectively.Based on the location of SPV,trigeminal nerve and auditory nerve,SPV can be divided into three types.The clinical characteristics and surgical strategies of different types were analyzed,besides,statistical methods were utilized to explore the related factors affecting the classification of SPV.Results: In this study,the type of SPV was proved to be type I in 31 patients(34.1%),type II in 46 patients(50.5%)and type III in 14 patients(15.4%).The main branches of SPV of all the patients were completely preserved by the appropriate treatment strategy,and the postoperative outcome was satisfying.There was no significant difference between the patients’ age,preoperative duration,gender,side,involved branches,hypertension or diabetes or responsible vessels(P > 0.05).Conclusion: Type II SPV is the most common in all patients.In this study,we observed no related factors affecting the type of SPV.The classification of SPV and the appropriate surgical strategies are good for the protection of SPV.Clinical study of individualized treatment of recurrent trigeminal neuralgia after microvascular decompressionObjective: Microvascular decompression(MVD)is regarded as a good treatment of trigeminal neuralgia(TN).Some patients may have pain recurrence after their prior MVD.This study was to explore the individualized treatment and efficacy of recurrent TN patients after MVD.Methods: TN Patients who received repeat MVD or PBC in the department of neurosurgery,Nanjing drum tower hospital from June 2018 to March 2019 were analyzed retrospectively.All the patients had received MVD before,but they got relapsed during follow-up.Results: 24 patients were enrolled in this study.11 of these showed a wide subarachnoid space and vascular compression could be observed from MR images.Thus,MVD was performed in these 11 patients.The average age of this group was 54.9 ± 5.20 years old,and the postoperative outcome was satisfying.Mild numbness was observed in 4 patients,and the numbness disappeared during the follow-up,there was no recurrence in this group till the end of follow up.The other 13 patients underwent percutaneous balloon compression surgery(PBC),and the average age was 65.8 ± 5.82 years old.Except for one patient,the others showed a good outcome.All patients had facial numbness after surgery,the other complications included masticatory muscle weakness in 4 cases and lip herpes in 2 cases.One case recurred during the follow-up.No severe complications such as hearing loss,cerebral hemorrhage,intracranial infection or cerebral infarction occurred in both groups.Conclusion: MVD and PBC are both effective in treating recurrent trigeminal neuralgia.The operation methods should be selected individually.