Individualized Surgical Treatment Of Drug-resistant Trigeminal Neuralgia

Objective: By comparing the efficacy and satisfaction of microvascular decompression(MVD),partial sensory rhizotomy(PSR)combined with MVD and gamma knife surgery(GKS)in the treatment of drug-resistant trigeminal neuralgia(TN),the individualized surgical treatment of patients with drug-resistant TN are explored.Methods: Through Chi-square test and Fisher's exact probability method,the clinical and short-term,medium-long term efficacy and satisfaction data of patients with drug-resistant TN,treated by surgery and GKS in Sichuan Provincial People's Hospital from September 2014 to December 2018,were analyzed retrospectively.Results: A total of 198 postsurgical TN patients followed up more than 1 year were enrolled.There were 135 cases in MVD group,22 cases in MVD+PSR group,30 cases in GKS group,and 11 cases in MVD-GKS combination treatment.The effective rates of short-term pain relief were 94.81% in the MVD group,100.00% in the MVD+PSR group and 70.00% in the GKS group,respectively.The differences among the three groups were statistically significant(P < 0.001).There was no statistically significant difference between the MVD group and the MVD+PSR group(P > 0.0167),and the differences among the MVD group,MVD+PSR group with the GKS group were statistically significant(P < 0.0167).At the last follow-up,the effective rate of pain relief was 93.33% in the MVD group,95.45% in the MVD+PSR group and 90.00% in the GKS group,respectively,with no statistically significant difference(P > 0.05).At the last follow-up,the rates of pain-free status were 73.33%in the MVD group,86.36% in the MVD+PSR group and 43.33% in the GKS group,respectively,with statistically significant differences(P<0.001).There was no statistically significant difference between the MVD group and the MVD+PSR group(P>0.0167).And there was statistically significant difference between MVD and GKS group(P<0.001),as well as MVD +PSR and GKS groups(P<0.0167).The recurrence rates were 15.56% in the MVD group,9.09% in the MVD+PSR group,and 16.67% in the GKS group,with no statistically significant difference(P > 0.05).The overallsatisfaction rate of patients was 85.19% in the MVD group,68.18% in the MVD+PSR group,and 80.00% in the GKS group,respectively,with no statistically significant difference(P > 0.05).The complete satisfaction rate was 68.15% in the MVD group,18.18% in the MVD+PSR group and 33.33% in the GKS group,respectively,with statistically significant difference(P < 0.001).The differences among the MVD group and the MVD+PSR group with the GKS group were statistically significant(P <0.001),while the difference between the MVD+PSR group and the GKS group was not statistically significant(P > 0.0167).Conclusion: 1.MVD and GKS are safe and effective treatments for drug-resistant TN patients: MVD has a better short-term pain relief rate than GKS;The effective rate of MVD and GKS was the same.The total analgesic effect and satisfaction rate of MVD were better than GKS.GKS are safer;2.In the MVD+PSR group,short-term and medium-long-term pain relief rates were high,but facial sensory disorders and other postoperative complications were extremely high,and the degree of complete satisfaction was the lowest.3.MVD-GKS combined therapy has a definite effect on patients with poor efficacy after the initial MVD and GKS;4.Combined with the neurovascular relationship shown by preoperative or postoperative reexamination,physical condition,systemic organ disease,patients' desire for treatment,the comprehensive considerations leads to the individualized selection of surgical treatment methods as MVD?GKS?PSR?PTR in patients with drug-resistant TN.