Long-term Efficacy And Influencing Factors Of Retrosigmoid Approach Microsurgery For Trigeminal Neuralgia

Purpose:Micro vascular decompression(MVD)and MVD combined with partial sensory rhizotomy(PSR)are effective surgical treatments for idiopathic trigeminal neuralgia(TN),but there are some ineffective or recurrent patients after operation.This study aimed to identify the factors that may influence the long-term outcomes after MVD or MVD+PSR.Methods:From March 2009 to December 2017,99 patients with idiopathic TN who underwent MVD or MVD+PSR in our hospital(40 MVD,59 MVD+PSR)were included in the study.The indications for MVD+PSR were as follows:vessels only contacted the nerve root,absence of arterial conflict,or failing to completely decompress from the arteries or veins.All patients were treated by one neurosurgeon and were followed up for at least 1 year.The outcomes were assessed with the Barrow Neurological Institute(BNI)Pain Intensity Scale.Results:The average follow-up duration was 63.0 months(range,13.2-118.8 months).Patients in the MVD group were younger than those in the MVD+PSR group(55.1 years and 60.5 years,respectively,P=0.012).A total of 62.5%of the patients in the MVD group and 69.5%of the patients in the MVD+PSR group had favorable long-term outcomes.The Kaplan-Meier survival analysis showed no significant difference in long-term outcomes between the two groups(P=0.202).No factors were associated with long-term outcomes after MVD.For MVD+PSR,a long duration of the disease(odds ratio(OR)6.967,P=0.016)was associated with unfavorable long-term outcomes,whereas pure arterial compression(OR 0.131,P=0.013)was associated with favorable long-term outcomes.Conclusion:For patients who are not suitable to undergo pure MVD,MVD+PSR can be used as an effective alternative.For MVD+PSR,patients with a long duration of symptoms may have poor long-term outcomes,while patients with pure arterial compression may have favorable long-term outcomes.