Relationship Between The Efficacy Of MVD In PTN And The Type Of Responsible Vessels

Objective: To analyze the relationship between the efficacy of micr ovascular decompression(MVD)in the treatment of primary trigeminal neuralgia(PTN)and the type of responsible blood vessels.Methods:The second hospital of hebei medical university were retrospectively analyzed in neurosurgery in June 2015 to June 2018,underwent micro vascular decompression for the treatment of 115 cases of primary trigem inal neuralgia patients,improve relevant inspection after admission,exce pt for secondary causes,in general anesthesia downlink trigeminal micro vascular decompression,according to the imaging data(craniocerebral M RI scan and 3 d TOF MRA imaging and 3 d-FIESTA sequence)and intraoperative surgery(different liability blood vessels),vascular types ar e divided into two groups according to responsibility,Fourteen patients w ith vertebrobasilar artery included in the vertebrobasilar artery compressi on group,and 101 patients without vertebrobasilar artery included in the small-vessel compression group.During the operation,an appropriate am ount of Teflon spacer was placed between the offending vessels and the brainstem to release the offending vessels that compressed the trigemin al nerve.The postoperative recovery of the patients was divided into :(1)cure: the postoperative facial pain completely disappeared,and there w as no pain at the time of follow-up;(2)improvement: postoperative facia l pain symptoms basically disappeared,occasional mild pain,but no dru g treatment;(3)inefficacy: no significant improvement in facial pain,whi ch still requires drug treatment.To observe,follow up and record the cur ative effect and complications of patients with different responsible bloo d vessels during postoperative hospitalization and follow-up,and make statistical analysis.Results:1.Short-term postoperative efficacy was good in 105 cases(91.3%,105/115): 11 cases(78.6%,11/14)in the vertebrobasilar artery compressi on group,and 94 cases(93.1%,94/101)in the small-vessel compression group.Postoperative short-term efficacy was poor in 10 cases(8.7%,10/115): 3 cases(21.4%,3/14)in the vertebrobasilar artery compression grou p,and 7 cases(6.9%,7/101)in the small vessel compression group.Ther e was no statistically significant difference in efficacy between the two groups(P=0.194).2.Long-term postoperative efficacy was good in 110 cases(95.7%,110/115): 11 cases(78.6%,11/14)in the vertebrobasilar artery compressi on group,and 99 cases(98.0%,99/101)in the small-vessel compression group.Postoperative long-term efficacy was poor in 5 cases(4.3%,5/115): 3 cases(21.4%,3/14)in the vertebrobasilar artery compression group,and 2 cases(2.0%,2/101)in the small-vessel compression group.The dif ference in efficacy between the two groups was statistically significant(P=0.013).3.Postoperative long-term dysfunction occurred in 10 patients: heari ng loss occurred in 1 patient,which occurred in the small-vessel compr ession group;Four patients had facial numbness,two in the small-vessel compression group and two in the vertebrobasilar artery compression gro up.Cranial nerve damage occurred in one case,which was the vertebrob asilar artery group.Lower limb weakness was found in 2 patients,all of whom were in the small-vessel compression group.One case recurred o ne year later in the small vessel compression group.One case presented facial muscle spasm,which occurred in the small vessel compression gr oup.There was no significant difference in postoperative long-term dysfu nction between the two groups(P=0.194).4.Logistic regression analysis s howed that responsible vessels including vertebrobasilar artery were an i mportant risk factor for poor long-term postoperative efficacy in patientswith primary trigeminal neuralgia(OR = 7.561,95%ci: 0.003-0.377).Conclusion:MVD has a high effective rate in the treatment of primary trigemin al neuralgia,with a low incidence of failure,complications and recurren ce.Primary trigeminal neuralgia patients with primary vertebrobasilar arter y involved primary blood vessels have poor long-term clinical outcomes.