Delayed Relief Of Trigeminal Neuralgia After Microneurosurgery With The Retrosigmoid Approach

Objective:Microvascular decompression(MVD)combined with partial sensory rhizotomy(PSR)with the retrosigmoid approach has become the most effective surgical treatment for trigeminal neuralgia(TN).There was variability in the pain relief processes in postoperative patients.The purpose of this study was to investigate delayed relief(DR)and its predictors after MVD and/or PSR for the treatment of TN and to study the long-term effects associated with DR.Methods:Patients with primary TN who underwent MVD and/or PSR by the same surgeon at the China-Japan Friendship Hospital from March 2009 to December 2017 were included in the study,and all patients were followed for at least 1 year after the operation.The degree of preoperative and postoperative pain was assessed by the Barrow Neurological Institute(BNI)pain intensity scale.Preoperative,intraoperative and postoperative differences between the DR and non-DR groups were compared,and the relationship between the various factors(including demographic data and clinical characteristics;intraoperative findings;and long-term effects)and DR was analyzed.Results:A total of 105 patients,including 20 patients with DR(19%),78 patients with non-DR(74%),and 7 patients without relief,were included in this study.The follow-up period ranged from 13 months to 118 months,with an average of 5.39 years(65 months).The duration of postoperative pain in the DR group was 3-365 days,with an average of 108 days.Statistical analysis found that no factor predicted the occurrence of DR,and the occurrence of postoperative DR did not affect the long-term effects of patients.Conclusion:For the patients with TN who experienced no immediate pain relief after MVD and/or PSR but experienced DR,DR did not affect the long-term effects.Therefore,it is recommended to observe patients for approximately 3 months after MVD and/or PSR and then evaluate the surgical effects;reoperations should not be performed immediately.