Curative Effect Appreciation Of Keyhole Completely Microvascular Decompression For Treatment Of Idiopathic Trigeminal Neuralgia

ObjectiveBy studying and comparing the therapeutic effect after operations of the improved microsurgical vascular decompression for treatment of primary trigeminal neuralgia and the effect of traditional microsurgical vascular decompression, to conclude the main points of the improved complete microsurgical vascular decompression, apply it to the clinical treatment and set up a group of cases of primary trigeminal neuralgia with particular remedial features. To observe the short-term and long-term post-treatment effects of microvascular decompression for treatment of idiopathic trigeminal neuralgia, to study the clinical symptom after the treatment of complete microsurgical vascular decompression to see whether there is any palindromia and the reasons if there is any. All these study will play an important role in the guidance for the clinical treatment and the judgment for prognosis.MethodsThe retrospective analysis is done on cases in our hospital with complete case file, including 21 from January, 1990 to July, 1998 and 27 from August, 1998 to October, 2006, which are cases of primary trigeminal neuralgia with microsurgical vascular decompression treatment. The 21 cases from January, 1990 to July, 1998 belong to the group of traditional treatment and the 27 cases from August, 1998 to October, 2006 belong to the group of improved treatment. There are 9 males and 12 females in the traditional group, aging from 39-63 while there are 12 males and 15 females in the improved group, aging from37-70. All these patients have been treated with carbamazepine and alepsin and the symptoms improved but then recurred. The traditional group is treated with the traditional microsurgical vascular decompression while the improved group is treated with the complete microsurgical vascular decompression. The differences in operating procedure between these two treatments are: 1. Completely release the cerebrospinal fluid of cistern and subarachnoid cerebrospinal fluid; 2. Trigeminal nerves should be sharply separated and fully exposed; 3. Identify the duty blood vessel, circumvolutio the nerve or the blood vessel with Telfon for a week and fix it with a titanium nipper, and the fixation fringer should be paralleled to the brainstem. 4. Never root to go out and come in brainstem should be explored at whole dimension, and carried on separability dissection; 5. The cases without duty blood vessel should be treatment of the vessels which possibly compressed the nevers, and perform on. decompression procedure. The follow up was performed by questionnaire or telphone investigation. Statistic analysis was performed by SPSS10.0 software. The P value less than 0.05 was consider as significant difference between two groups on statistics.ResultsStatus of vessel compression from traditional treatment group and improved treatment group were described in brief. In generally, the characteristics of blood vessel and never compression were no significant difference. The therapeutic effect of traditional treatment was described as bellow. There was 10 patients cured, 8 patients improved and 3 patients failed through the traditional operation. The therapeutic effect of improved treatment was descrided as bellow.There was 17 patients cured and 10 patients improved by the improved operation. The postoperative complications were 47.6 percents (10/21) and 40.7 percents (11/27) in traditional and improved treatment respectively. It was no difference in sexy comstrution, age or course of disease from two groups.However, it was significant difference in hospital day, operation time and therapeutic effect from two therapy methods. The hospital day and operation time of the patients received the improved operation were shorter than the traditional. The improved operation had an advantage to the patients in therapeutic effect.Conclusion Trigeminal neuralgia was defined as the megalgia that temporal, recurrent and paroxysm in the prosopo-trigeminal nerves areas, and most scholars considered microvascular compression as the principal etiopathogenisis of that. The treaments for trigeminal neuralgia included medication, blockade therapy, per cutem selectivity ganglion semilunare radiofrequency electric coagulation, sensory root of trigeminal nerve root amputation and trigeminal nerves microvacular decompression were used to resolve the problem. In the series of therapeutic measure, indication should be take care of, especially for the recrudescent or inefficent of medicaiton. As if it happened, microsurgical neuro-vascular decompression was the preferred method to deal with it. The traditional microsurgical neuro-vascular decompression needed to open a comparatively large bony window, in order to find the duty blood vessel, then pad a suitable dacron or Teflon cotton piece between the vessel and the nerve, or electric coagulate the duty blood vessel to release the compression. This traditional operation could cause many defects such as comparatively serious operation wound, longer operation time, more occurrence of complication and hard to postoperative recovery. The improved operation was better than the traditional in all aspects, because of its comparatively small bony window, aviodance of the nerver compression by vascular regeneration. It was considered that whole section disposal and wrap up the trigeminal nerves played critical role in the improved microsurgical neuro-vascular decompression..