Therapeutic Effect Of Microvascular Decompression For Different Responsible Vessels Of Primary Trigeminal Neuralgia

Objective:Microvascular decompression was used to treat primary trigeminal neuralgia,to identify the type of blood vessels during surgery,and to explore the clinical efficacy of primary trigeminal neuralgia under different vascular compression.Methods:Clinical retrospective analysis was performed to select patients with neurological functional neurology in our hospital.The admission time was from September 2016 to April 2018.A total of 187 patients with primary trigeminal neuralgia who underwent microvascular decompression were screened for telephone,WeChat,and outpatient follow-up.The follow-up period was 6 months and 12 months after surgery.A total of 158 patients who participated in the follow-up were included in the study data;29 patients who were lost in the middle of the study were not involved in the study.According to the patient’s postoperative efficacy,the patient’s gender,age,duration of disease,pain side and different responsible blood vessels were statistically analyzed to screen out the relevant factors affecting the postoperative efficacy.Results:(1)Among the 158 patients in the observational study,according to preoperative imaging data(3D-TOF-MRA)and intraoperative surgical exploration,there were 94 cases of responsible arterial compression for arterial venous compression;Thirty-six cases;the responsible blood vessels were 28 cases of simple venous compression.(2)Postoperative observation and follow-up of patients with simple arterial compression were completely cured in 90 cases(95.74%),non-healing in 4 cases(4.26%);arteriovenous combined compression was completely cured in 26 cases(72.22%),10 cases(27.78%)were non-cure;19 cases(67.86%)were completely cured after venous compression,and 9 cases(32.14%)were non-healing.A total of 135 patients were cured after surgery,and the total cure rate was 85.4%.(3)Four patients had recurrence after operation.One of the patients had a responsible blood vessel for arteriovenous,and the other three patients had a simple blood vessel.Later,in our hospital,the percutaneous round hole was used to puncture the trigeminal semilunar balloon.The compression improved after surgery.There were 13 patients with different degrees of tinnitus,which were improved after vasodilation and nutritional neurotherapy.There were 2 patients with subcutaneous effusion 1 month after operation,and the amount of effusion was not large,and they were cured after being treated with compression clamp.There were no intracranial infections,cerebellum,brain stem infarction,and no deaths.(4)Statistical analysis showed that the postoperative cure rate of patients with simple venous compression and venous compression was lower than that of patients with simple arterial compression,and the difference was statistically significant(P<0.05).The patient’s gender,age,time of onset and pain side did not have much effect on postoperative outcome,and there was no statistical difference(P>0.05).Conclusions:(1)Microvascular decompression has a high efficiency in the treatment of primary trigeminal neuralgia,and it is currently the only method to treat trigeminal neuralgia according to the cause.(2)Diverse and complex blood vessels often lead to poor or even ineffective microvascular decompression,and venous factors are unfavorable factors for postoperative efficacy.