Study On The Treatment Of Primary Trigeminal Neuralgia

【Objective】To compare the efficacy of microvascular decompression and gamma knife in the treatment of primary trigeminal neuralgia,and to further explore the advantages and disadvantages of microvascular decompression under awake anesthesia and general anesthesia.【Methods】To retrospectively analyze the data of TN patients who were admitted for treatment in our hospital from June 2015 to August 2020 and met the inclusion criteria(including: age,gender,course of disease,affected side,involved branches,preoperative pain degree,underlying disease,past History of surgical treatment,etc.).A total of 124 patients were enrolled,84 in the GKRS group and 40 in the MVD group.The research is divided into two parts:(1)According to the different treatment methods,it is divided into microvascular decompression(MVD)group and gamma knife(GKRS)group,the pain relief and recurrence after treatment were followed up in two groups.The onset time,Short-term and long-term curative effects and complications,treatment costs,postoperative hospital stay of the two treatment methods were compared.(2)According to the different methods of anesthesia,MVD is further divided into awake anesthesia group(AA)and general anesthesia group(GA).The preoperative baseline data of the two groups of patients are collected.All patients use the Hamilton Anxiety Scale(HAMA)before surgery.Anxiety Scale and Barthel Index(BI)were used to evaluate psychological anxiety and daily living ability;Visual Analogue Scale(VAS)was used to record the immediate pain relief of patients within 24 hours after surgery;The Barrow Neurological Institute(BNI)scale was used to assesses the long-term postoperative pain relief and recurrence;records the postoperative recovery of patients(including the time to resume eating,changes in the BI score),postoperative hospital stays,expenses and complications.Perform statistical analysis on all the data obtained from the two parts of the study and draw conclusions【Results】The first part(comparative study between the MVD group and the GKRS group):(1)Therapeutic effect: the onset time of postoperative pain relief in the MVD group was shorter than that in the GKRS group,and the difference was statistically significant(P<0.05);the short-term(3,6months)and long-term(>6months)effective rate and cure rate in MVD group were higher than those in GKRS group,the difference was statistically significant(P<0.05).;the long-term(>6 months)recurrence rate in MVD group was lower than GKRS group(7.5% vs22.6%),the difference was statistically significant(P<0.05);the degree of pain relief in the MVD group was better than that of the GKRS group,and the difference was statistically significant(P<0.05)(2)Surgery-related complications: The incidence of surgery-related complications in the GKRS group was higher than that in the MVD group(38.1% vs 17.5%),and the incidence of facial numbness was also higher than that in the MVD group(34.5% vs7.5%),the difference was statistically significant(P<0.05)(3)Treatment cost: The average postoperative hospital stay and hospitalization expenses in the GKRS group were less than those in the MVD group,and the difference between the two groups was statistically significant(P<0.05)The second part(comparison between different anesthesia methods in the operation group):(1)Therapeutic effect: both the AA group and the GA group have a higher immediate postoperative remission rate,although the immediate complete remission rate of the AA group was higher than that of the GA group(93.3% vs 80%),but the difference between the two groups was not statistically significant(P>0.05).The effective rate,cure rate and recurrence rate of the AA group and the GA group in the long-term(>6 months)after operation were similar,and there was no statistical difference(P>0.05).(2)The incidence of complications: the incidence of surgery-related complications in the two groups were similar and there was no statistical difference(P>0.05);but the postoperative complications of the respiratory system and digestive system in the AA group were significantly less than those in the GA group,and the difference was statistically significant(P<0.05).In addition,although the central nervous system,circulatory and urinary system complications in the GA group occurred more than those in the AA group,the difference was not statistically significant(P>0.05)(3)Treatment cost: The recovery time of eating after the operation and BI score on the day and 7-day after operation in the AA group was better than that of the GA group,and the difference between the two groups was statistically significant(P<0.05).Postoperative hospitalization days and hospitalization expenses in the AA group showed a trend lower than those in the GA group,but the difference was not statistically significant(P>0.05)【Conclusions】(1)The most direct evidence for vascular compression of the nerve as a causative factor for PTN was obtained.(2)MVD has a rapid onset,good curative effect,stable,and few surgical complications.,it is the first choice for the treatment of PTN patients with vascular compression of nerves;GKRS is a simple,effective,and economical treatment option for PTN patients who are intolerant and unwilling to undergo craniotomy.(3)The application of AA technique to MVD in the treatment of PTN has promotion value.It not only provides physicians with an opportunity to evaluate the effect of decompression during the operation,but also promotes the rapid recovery of patients after surgery and reduces the incidence of postoperative complications.