A Clinical Comparative Study Of Two Surgical Methods For The Treatment Of Primary Trigeminal Neuralgia In A Teaching Hospital

Research backgroundTrigeminal neuralgia is a common disease both domestically and abroad,its clinical manifestations is characterized by repeated episodes of transient shock-like severe pain of the facial trigeminal nerve distribution area,which cause severe damage to the patients'physical and mental health.At current stage,trigeminal neuralgia is usually divided into primary and secondary categories in clinical.Primary trigeminal neuralgia treatment methods includes drug therapy,block therapy,radiofrequency thermocoagulation,trigeminal nerve microvascular decompression surgery and so on,among which trigeminal nerve microvascular decompression have been recognized as the first surgical method choice.In recent years,with the continuous development of neuroendoscopic techniques,neuroendoscopy applications continue to expand in the field of neurosurgery,and purely neuroendoscopic microvascular decompression for the treatment of primary trigeminal neuralgia gradually become the mainstream because of its minimally invasive,clear vision and many other advantages.ObjectivesCurrently,neuroendoscopic technique has become an important part of minimally invasive neurosurgery.With the improvement of equipments and the development of surgical technique,the application of neuroendoscopy has gradually expanded.This study compared the related information of purely endoscopic and traditional microscopic microvascular decompression in the treatment of primary trigeminal neuralgia.The safety and superiority of neuroendoscopy in the treatment of trigeminal neuralgia were discussed and evaluated,which provided an objective clinical basis for the treatment of trigeminal neuralgia in regard of the choice of surgical methods.MethodsRetrospective analysis was conducted of 162 patients with primary trigeminal neuralgia in the Neurosurgery Department of Qilu Hospital of Shandong University administered from December 2013 to December 2016(67 cases received pure endoscopic microvascular decompression,95 cases underwent traditional microscopic microvascular decompression).Related parameters of both methods were analyzed.The surgical incision and the operative field were compared,the difference between the time of operation,the visual field exposure,postoperative pain relief were analyzed,and the incidence of other central nervous system injury,facial numbness,facial paralysis,hearing loss,cerebrospinal fluid leakage,infection and other complications as well as the recurrence of pain were statistically analyzed.The measurement data were compared by the t test method,the count data were compared by the chi-square test,the Kaplan-Meier analysis of recurrence was conducted in this study,and a test level of P<0.05 is considered as statistical significance.Main resultsThe actual follow-up number of patients of the 171 patients with primary trigeminal neuralgia included in the study is 162(67 cases received pure endoscopic microvascular decompression,95 cases underwent traditional microscopic microvascular decompression),with an follow-up rate of 94.74%.For the pure endoscopic group,65 cases achieved immediate postoperative pain control,2 case obtained pain relief,the complete relief rate was 97.01%.The operation time ranged 70?100min,with an average of 85.31min.The blood loss ranged 20?40ml,with an average of 30.70ml.Postoperative hospital stay ranged 5?8d,with an average of 6.209d.2 cases of patients suffered facial numbness of the affected side,both were improved after treatment,the incidence rate of postoperative complications was 2.99%.3 cases of recurrence occurred with an rate of 4.48%.For the microscopic group,83 cases achieved immediate postoperative pain control,12 case obtained pain relief,the complete relief rate was 87.37%.The operation time ranged 85?120min,with an average of 102.6min.The blood loss ranged 50?150ml,with an average of 104.7ml.Postoperative hospital stay ranged 6?11d,with an average of 8.649d.6 cases of patients suffered facial numbness of the affected side,5 patients had tongue numbness besides facial numbness,and 2 patient with tinnitus,1 patient with dizziness,all symptoms were improved after treatment,the incidence rate of postoperative complications was 14.74%.14 cases of recurrence occurred with an rate of 14.74%.There were no deaths during follow-up.Neuroendoscopy and microscopy were both effective in relieving the symptoms,but the neuroendoscopy is better(P=0.0314),while the endoscopic group enjoyed prevalence in the average operation length(P<0.0001),blood loss(P<0.0001),postoperative hospital stay(P<0.0001),complication rate(P = 0.0135),and recurrence rate(P=0.0359)compared with the microscopy,with statistically significances.ConclusionsBoth pure endoscopic microvascular decompression and conventional microvascular decompression were effective in the treatment of primary trigeminal neuralgia,with satisfying outcome and safety.However,the pure endoscopic microvascular decompression enjoyed prevalence in the average operation time,blood loss,postoperative hospital stay,and incidence of complications compared with the microscopic group.Pure neuroendoscopic microvascular decompression is an optimum operative choice for the trigeminal neuralgia better treatment,which is worth clinical application.Meanwhile,purely endoscopic surgery has higher requirements of the operator's skills and experiences,further strengthen of learning and training needs to be conducted,on the skills of purely endoscopic microvascular decompression surgery for the treatment of primary trigeminal neuralgia.