Analysis Of The Clinical Efficacy Of Microvascular Decompression For Treatment Of Primary Trigeminal Neuralgia

Background:Trigeminal neuralgia is a rare, episodic facial pain that is unilateral, electric shock-like.The incidence of trigeminal neuralgia was about 4-5/100000.The exact pathophysiology of how vascular compression leads to trigeminal neuralgia remains speculative. Popular hypotheses include a combination of central demyelination of the nerve root entry zone and reinforcing electrical excitability (the ignition hypothesis).The diagnosis mainly depends on the medical history and clinical manifestations. Primary trigeminal neuralgia results in considerable interference with activities of daily living,so an effective treatment is essential.Medications should be offered as preference treatment for pain control. For patients with TN refractory to medical therapy early surgical therapy may be considered. Microvascular decompression is the main surgical treatment. However for the determination of responsible blood vessels,the treatment of petrosal vein and other venules,the treatment of no reasonable compression vessels,techniques are not the same,then the clinical efficacy is not all teh same.Objective:l.To analysis the clinical efficacy of Microvascular Decompression(MVD) for treatment of primary Thrigeminal Neuralgia(TN).2.To investigate the surgical techniques of Microvescular Decompression.Method:A retrospective review was performed to analyze the clinical data of 181 primary trigeminal neuralgia patients that underwent Microvescular Decompression from 2010.1 to 2015.12 in our department. We reviewed the patients’ general information, clinical manifestation, intraoperative findings, pain relief and neurologic impairment.Result:The group of 181 cases included 77male cases(42.54%) and 104 female cases(57.46%).The age ranged from 31 to 79.All the 181 patients received systematic drug therapy before Microvascular decompression(MVD) Reasonable compression vessels were found in 174 patients (96.13%) and none reasonable compression vessels in 7 cases(3.87%). Among the 174 patients which reasonable compression vessels were found, artery compression was found in 155 cases(89.08%), vein compression in 8 cases(4.60%), artery combined with vein compression in 11 cases(6.32%). Reasonable compression vessels located in REZ zone in 150 cases(86.21%), the petrous segment (near Meckel cave) 16 cases(9.20%), both the two areas in 8 cases (4.60%). For all the 174 patients that we found reasonable compression vessels,172 cases(98.85%) had excellent release,1 case(0.57%) had good release,l cases(0.57%)failed result within 7 days after operation. All the 174 cases excellent release after a year followed up. For all the 7 patients that we found none reasonable compression vessels,1 cases(14.29%)had excellent release,5 case’s(71.43%)had good release,1 case (14.29%)had failed result within 7 days after operation.6 cases(85.71%) received excellent release after a year followed up,1 case(14.29%) underwent partial rhizotomy (PR) of sensory root of trigeminal nerve. Postoperative facial numbness appeared in 17 cases(9.39%) of the 181 cases,6 cases recovered completely 3 days later,10 cases recovered completely 7days later,1 case recovered some degree; dizziness in 6 cases(3.31%),2 cases recovered completely 2 days later,4 cases recovered completely 5 days later; CSF leakag 2 cases, recovered completely; no hearing loss, infarction, hemiplegic paralysis.Conclusion:1. Responsible blood vessels are mainly located in REZ, can also be located in the far; most of responsible blood vessels are arteries,a small number of responsible blood vessels were veins.2. Careful exploration of the whole course of the trigeminal nerve is the key to the successful operation of micro vascular decompression for trigeminal nerve.3.The microvascular decompression of trigeminal nerve has a definite therapeutic effect on the treatment of primary trigeminal neuralgia.4. Preserving petrosal venous during operation is benificial to decrease postoperative complications.5. The clinical efficacy of microvascular decompression (MVD) of the trigeminal nerve is closely related to the surgical operation and the personal experience of the operation.