| Objective:In this study,we collected the preoperative clinical data,the responsible vessels determined during the operation and the operation time under the microscope of the patients with primary trigeminal neuralgia(PTN)treated by microvascular decompression(MVD),and explored whether there were differences between these indicators and the prognosis,so as to study the risk factors for the prognosis of microvascular decompression(MVD)in the treatment of primary trigeminal neuralgia(PTN),and provide clinical experience and guide clinical work.Method:This retrospective study adopted strict criteria for inclusion and exclusion.A total of 157 cases of primary trigeminal neuralgia treated in the Department of Neurosurgery of the Third Affiliated Hospital of Soochow University from March 2008 to March 2019 were included in,all performed by the same surgeon.The Barrow Neurological Institute Pain Score(BNI score)was used to evaluate and record the degree of preoperative pain,postoperative pain and the pain at the time point of follow-up.The data of gender,age(during operation),hypertension,diabetes,pain side,the branch of trigeminal nerve involved in pain,course of disease,preoperative BNI score(Ⅴ),preoperative surgical intervention,the responsible blood vessels determined during the operation,the operation time under the microscope,surgical effect,postoperative complications were collected and sorted out.Follow-up was performed after surgery,with an average follow-up time of 44.2 months Definition of prognosis:BNI score Ⅰ was defined as cure(pain disappeared),BNI score Ⅱ as effective,and Ⅲ-Ⅴ as ineffective in MVD.BNI score Ⅰ was defined as cure(pain disappearance),BNI score Ⅱ as effective,BNI score Ⅰ and Ⅱ as pain relief,and BNI score Ⅰand Ⅱ became Ⅲ-Ⅴ(time point of follow-up)as relapse.Definition of short-term and long-term:the short-term is immediate after operation,and the long-term is not less than one month after operation.According to the effect of recent treatment,all cases were divided into two groups:the group with recent cure and the group without recent cure,the univariate analysis was used for the indicators above.According to the long-term surgical effect,the patients were divided into two groups:the long-term pain remission group and the long-term pain non-remission group,the univariate analysis was performed,then the multivariate logistic regression analysis was carried out on the indicators with P<0.15.According to the recurrence,the patients were divided into recurrence group and non-recurrence group,the same statistical analysis method was used to get the risk factors of pain recurrence.Cox proportional hazards model was used to explore the factors affecting the recurrence time,and the Kaplan-Meier curve of the factors was drawn.Statistical analysis was performed using SPSS 21.0 and RStudio(Version 1.2.5019)statistical software,and P<0.05 was considered to have significant differences and statistical significance.Results:1.General information results:Among the 157 patients,98 were female(62.4%),59 were male(37.6%).The average age was 61.61±10.26 years,the course of disease was 56.62±47.93 months.65(41.4%)patients had left side pain and 92(58.6%)patients had right side pain.71 cases(45.2%)with hypertension,8 cases(5.1%)with diabetes.In terms of trigeminal branches involved in pain,there were 4 cases(2.5%)in V1,22 cases(14.0%)in V2,49 cases(31.2%)in V3,15 cases(9.6%)in V1+V2,2 cases(1.3%)in V1+V3,54 cases(34.4%)in V2+V3 and 11 cases(7.0%)in V1+V2+V3.The preoperative BNI scores were Ⅲ、Ⅳ、Ⅴ in 2 cases(1.3%),56 cases(35.7%)and 99 cases(63.0%),respectively There were 25 cases(15.9%)with preoperative surgical intervention.There were 110 cases(70.1%)with simple arteries,41 cases(26.1%)with arteries and veins,and 6 cases(3.8%)with simple veins.The average operating time under the microscope was 93.94±41.65 minutes.The short-term cure rate was 84.7%,the short-term remission rate was 95.5%,the inefficiency rate was 4.5%,the long-term cure rate was 59.9%,the long-term remission rate was 67.5%,and the recurrence rate was 28.7%.2.Statistical results:In the short-term cured group(n=133)and the short-term uncured group(n=24),the univariate analysis results showed that the P value of the simple veins as the responsible blood vessel was 0.016<0.05,and there was no significant difference in other indicators(P>0.05).Univariate analysis results of long-term pain relief group(n = 106)and long-term pain relief group(n=51):the P values of age(at the time of surgery)≥70 years,preoperative BNI score(V),the simple artery,SCA+PV and SCA+AICA as the responsible blood vessel were below 0.15.And these indicators were included in multivariate logistic regression analysis,no significant difference was found between these indicators and long-term pain relief(P>0.05).Univariate analysis results of the recurrence group(n=45)and the non-recurrence group(n=112):the p values of age(at the time of surgery)≥ 70 years old,the simple artery,petrous vein,SCA+PV as the responsible blood vessel were below 0.15,multivariate logistic regression analysis results:age(at the time of surgery)≥ 70 years old with P=0.012<0.05.Kaplan-Meier curve of factors influencing recurrence time showed that women relapsed earlier than men(P=0.048<0.05),and the median recurrence time was 360 daysConclusion:1.Micro vascular decompression is a safe and effective surgery,and the short-term cure rate and remission rate are both high.2.The simple veins as the responsible blood vessel is the factor that affects the difference in the short-term cure rate after MVD.The type and number of the vessel is not the factor that affects the difference in the short-term cure rate.3.The type and number of responsible vessels are not the factors that affect the difference of pain relief rate in the long term of MVD treatment of PTN.4.The type and number of responsible vessels are not the factors that affect the difference of pain recurrence rate after MVD.5.Pain recurrence mostly occurs within 5 years,women relapse earlier than men.6.Age(at the time of surgery)≥ 70 years is the risk factor of pain recurrence. |
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