Safety and efficacy of pure microvascular decompression for trigeminal neuralgia

Abstract

Objective To analyze the efficacy and safety of pure microvascular decompression (MVD) for trigeminal neuralgia (TN), and to screen related risk factors for TN recurrence.  Methods A total of 286 primary TN patients underwent pure MVD. Barrow Neurological Institute (BNI) grade was used to evaluate the relief of TN before and after surgery and during the follow-up. Postoperative complications were recorded, including facial numbness of operation side, hearing loss of operation side, cerebrospinal fluid (CSF) leakage, poor wound healing, intracranial infection and hydrocephalus. The recurrence during follow-up was also recorded. Univariate and multivariate forward Logistic regression analysis were used to screen related risk factors of recurrent TN.  Results Of all patients, 18 cases (6.29%) had slight facial numbness of operation side after surgery, 13 cases (4.55% ) had hearing loss of operation side after operation. One (0.35%) had CSF leakage, and was cured after lumbar cistern drainage. One (0.35%) had no wound healing, and was cured after bone wax and repairing titanium mesh were removed in the reoperation. Two cases (0.70% ) had intracranial infection and were cured by antibiotic therapy. One (0.35%) had hydrocephalus and was cured after external ventricular drainage. Of 286 patients, 26 cases (9.09%) were lost during the follow-up, 13 cases (4.55%) had no pain relief after surgery, 13 cases (4.55%) had partial pain relief after surgery and 234 cases (81.82%) had complete pain relief after surgery. The follow-up period of 234 cases was a mean of 31.29 months. During follow-up, one case (0.35%) died of heart disease, and 28 cases (9.79%) had pain recurrence. Kaplan-Meier curve showed the rate of complete pain relief was decreased with time, the recurrence rate was 5.4% one year after surgery, 15.2% 3 years after surgery, and 21.2% 5 years after surgery. Univariate and multivariate forward Logistic regression analysis showed preoperative BNI grade Ⅴ was independent risk factor for recurrence of TN (OR = 2.385, 95%CI: 1.063-5.353; P = 0.035).  Conclusions Pure MVD for treating TN is safe and effective, without postoperative death or severe complications.

DOI: 10.3969/j.issn.1672-6731.2018.10.003