Analysis Of The Efficacy Of Microvascular Decompression In The Treatment Of Primary Trigeminal Neuralgia

Objective:To observe the effect of microvascular decompression(MVD)in the treatment of primary trigeminal neuralgia(PTN)in different branches,and to analyze the related factors affecting the curative effect.Methods:The clinical data of 190 patients with TN who underwent MVD in the Department of Neurosurgery of the first Clinical Hospital of Shansi Medical University from January 2017 to January 2020 were analyzed retrospectively.Among them,13 cases were affected by the ophthalmic branch of trigeminal nerve(V1),17 cases by maxillary branch(V2),28 cases by mandibular branch(V3),17 cases by V1-V2,34 cases by V2-V3 and 30 cases by V1-V3.The postoperative curative effect was evaluated by combining the degree of pain relief and the severity of complications,and the relevant factors affecting the curative effect after MVD were statistically analyzed.Results:Through univariate analysis,the results showed that there was no significant correlation between gender,age,pain side,course of disease and postoperative curative effect among the factors included in the study(P > 0.05).There were 93 patients in arterial group(SCA76,6 AIVA,2 PICA,2 VA,5 SCA+ AICA,5 SCA+PICA2),17 in vein group,26 in arteriovenous group(SCA+V22,AIVA+ V3,PICA+ V1),3 in irresponsible vessel group(arachnoid thickening group),and the arterial compression group had the most number and the best postoperative effect,and there was significant difference between different responsible vessels and postoperative effect(P < 0.001).The pain involved V1 branch in 13 cases,V2 branch in 17 cases,V3 branch in 28 cases,V1+V2 branch in 17 cases,V2+V3branch in 34 cases,V1+V2+V3 branch in 30 cases,and divided into two groups according to whether the pain involved V2 branch,98 cases were involved in V2 branch and 41 cases were not involved in V2 branch.The effect of pain involving different branches was significantly different from that of MVD(P <0.05).The results of multivariate Logistic regression analysis showed that the involvement of V2 branches was an independent risk factor for postoperative outcome in patients with PTN(OR=0.196,95%CI0.059-0.625,P=0.008).Conclusion:Simple arterial compression is the main compression vessel of primary trigeminal neuralgia,and the postoperative effect is better when the responsible vessel is simple arterial compression,and the postoperative effect of patients with pain involving V2 branches is not as good as that of patients without V2 branches.