Analysis Of Related Prognostic Factors Affecting The Microvascular Decompression For Trigeminal Neuralgia

BackgroundTrigeminal neuralgia is a relatively common functional disorder characterized by recurrent and intense electric shock-like facial pain.It can be classified as classical(primary due to mcrovascular compression),secondary(secondary to peripheral occupying disease,etc.),and idiopathic(no obvious cause found),with classical trigeminal neuralgia being the most common.The first-line treatment for classical trigeminal neuralgia is sodium channel blockers represented by carbamazepine and oxcarbazepine,which can control the symptoms and improve the quality of life in most patients.However,sodium channel blockers may have severe side effects and cause great suffering to patients,which eventually leads to the failure of conservative treatment marked by unplanned withdrawing from the medication.Microvascular decompression is the surgical treatment of choice for refractory classical trigeminal and can provide the highest benefit to patients who meet the indications for the surgery.However,the factors affecting short-term and long-term outcome of microvascular decompression are controversial,and it is not clear whether sodium channel blockers as first-line treatment has an effect on surgery.ObjectiveTo summarize the clinical characteristics of trigeminal neuralgia patients and to investigate the affecting factors related to microvascular decompression on the shortterm and the long-term outcome of microvascular decompression.MethodsA total of 63 patients with classical trigeminal neuralgia underwent microvascular decompression at the First Affiliated Hospital of Zhengzhou University,PR China,from 2013 to 2019.The data was collected through telephone follow-up and electronic medical records in April 2020,the short-term surgical outcome and the long-term follow-up data were estimated by univariate and multivariate analysis.ResultsIncluded were 63 patients with classical trigeminal neuralgia:43 women and 21 men(female:male=1:0.49),with a mean follow-up of 28 months(4 to 80 months),a mean age at surgery of 55 years(32 to 81 years),and a mean duration of symptoms of 48 months.Postoperatively,59 cases had good surgical results,4 cases had failed surgery(6.3%),and 45 cases had immediate postoperative remission(71.4%).At postoperative follow-up with a cross-section in mid-April 2020,recurrence was observed in 15 cases(23.8%).The multivariate analysis result indicated that multiple vessel compression and immediate remission were significant predictors for shortterm outcomes of Microvascular Decompression(P<0.05),and preoperative Carbamazepine treatment history was not a significant predictor in the meantime.The multivariate analysis result for the long-term outcome of Microvascular Decompression indicated that the medication history of preoperative Carbamazepine treatment could predict its postoperative recurrence(P<0.05).After cut-point management,the Kaplan-Meier survival analysis result showed that the survival rate of the group with preoperative Carbamazepine treatment history for 3 months or less was higher than that of the group with the medication history for over 2 years(P<0.1)by log-rank test.ConclusionIn patients with classical trigeminal neuralgia,short-term surgical outcomes are poorer in patients found to have multiple vessel compression and no immediate remission,and long-term outcome is better in patients had short-term preoperative Carbamazepine medication history.