Comparison Between PBC,RFT And MVD For The Treatment Of Trigeminal Neuralgia

BackgroundTrigeminal neuralgia(TN)refers to the neuropathic pain confined to the distribution of one or more branches of the trigeminal nerve.The pain of TN is always described as electric shocking,shooting,or knife cutting.It usually breaks out and stops suddenly and repeatedly and can be induced by a non-nociceptive stimulus.Trigeminal neuralgia mainly occurs in people between 48 and 59 years old,but the latest survey shows that the affected people tend to be younger,and the prevalence rate is increasing,which has a serious impact on the quality of life of patients and also increases the cost of medical treatment.For the treatment of primary trigeminal neuralgia,carbamazepine or oxcarbazepine is the first choice.When the effect of oral medicine is poor or the patient cannot tolerate the side effects of the drug,surgical treatments should be considered.The commonly used surgical methods include percutaneous balloon compression(PBC),radiofrequency thermocoagulation of the trigeminal ganglion(RFT),microvascular decompression(MVD),gamma knife surgery(GKS),and so on.Patients suffering from primary trigeminal neuralgia are usually treated by the first three methods.Each of the three treatments has its own advantages and disadvantages.However,there is still a lack of direct comparative studies among all these three therapies,and there is no high-level evidence on the merits and demerits of their therapeutic effects and how to choose among them.ObjectiveOur study aims to follow up primary trigeminal neuralgia patients undergoing MVD,PBC,or RFT during the same period to perform a retrospective study,to compare the curative effect and prognosis of these three treatments,in order to provide better guidance for the therapy of primary trigeminal neuralgia.MethodsThe electronic medical record system was searched to collect patients with primary trigeminal neuralgia who met the inclusion criteria.Then,we extracted patients’general information and disease-related information through a pre-designed data extraction table.The PBC group was regarded as the standard group,and the age,gender,side,range of involved nerves,course of the disease,trigger point,and other factors were taken as the matching factors for propensity score matching.Those samples with the highest matching score were selected from MVD and PRT groups for 1:1 matching and then included for analysis.The general information,pain score,length of stay in the hospital,hospitalization costs,postoperative numbness,postoperative recurrence,and complications were statistically analyzed.ResultsTwenty-four cases were included in each group.There were no statistically significance among the three groups in age,sex,affected side,course of disease,follow-up time,pain score at admission,whether it was the first occurrence,previous trigeminal nerve surgery history,whether the relationship between trigeminal nerve and blood vessel was close,or underlying diseases.There were no statistically significance in VAS scores between the three groups at admission,discharge and follow-up(P>0.05).VAS scores at discharge and follow-up were lower than at admission in all three groups,and the difference was statistically significant(P<0.05).Compared with MVD group,there was no statistically significant difference in length of stay between PBC group and MVD group(P>0.05).Compared with PBC group and MVD group,the length of stay in RFT group was shorter and statistically significant(P<0.05).The hospitalization cost of RFT group was the lowest,followed by PBC group and the highest in MVD group,with statistical significance(P<0.05).Compared with MVD group,the incidence of postoperative numbness in PBC group was statistically significant(P<0.05),there was no statistically significant difference in postoperative numbness incidence between the PBC group and the RFT group,or between the RFT group and the MVD group(P>0.05).The difference of recurrence rate among the three groups were not statistically significant(P>0.05).The incidence of adverse reactions in PBC group and MVD group were higher than that in RFT group,and the difference was statistically significant(P<0.05),the incidence of adverse reactions in MVD group was higher than that in PBC group,and the difference was statistically significant(P<0.05).Conclusions1.PBC,RFT and MVD can effectively relieve the pain of patients suffering from trigeminal neuralgia,and the treatment effect of these three methods is similar at discharge and within 1 year after operation.Furthermore,the recurrence rate and recurrence time one year after operation of them are similar.2.PBC and RFT are cheaper,and the incidence of postoperative complications is relatively low and slight,thus they have high cost performance.3.The cost of MVD is the most expensive and the incidence of postoperative complications is the highest and the most serious.However,MVD has the lowest incidence and the shortest duration of postoperative numbness.