【原】三叉神经痛复发：微血管减压与经皮球囊压迫的比较：一项为期五年的随访研究（四）

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本次文献选自Chaves JPG, DE Oliveira TVHF, Francisco AN, Trintinalha MO, Carvalho NVP. Trigeminal neuralgia recurrence: a comparison of microvascular decompression and percutaneous balloon compression: a five years follow-up study. Arq Neuropsiquiatr. 2021 Jan;79(1):51-55.本次学习由谢珺田副主任医师主讲。

We found that six patients (of a total of 14) had recurrence 9.0 months after MD and 15 patients (of a total of 23) had recurrence 11.8 months after PBC as shown in Tables 2 and 3. Two patients submitted to MD who had recurrence also underwent PBC.

我们发现，如表2和表3所示，6名患者（总共14名）在MD后9.0个月复发，15名患者（共23名）在PBC后11.8个月复发。其中MD的两名复发患者之前也接受过PBC。

Table 2 details the treatment data of 37 patients who underwent PBC or MD. The p value for the recurrence rate in PBC or MD (0.508), as well as the p value for the time of recurrence (0.381), was not significative.

表2详细列出了37名接受PBC或MD治疗的患者的治疗数据。PBC或MD的复发率p值（0.508）以及复发时间p值（0.381）均无统计学意义。

Twelve patients had NVC on the MRI, being the most involved vascular structures the superior cerebellar artery, basilar dolichoectasia and anterior inferior cerebellar artery. All patients with NVC underwent surgical treatment, and only 3 experienced pain recurrence (p=0.029). The Kaplan Meier survival test comparing type of surgery (PBC or MD), time for recurrence in months and the presence of recurrence is represented in Figure 1.

12例患者在MRI上有NVC，累及最多的血管结构包括小脑上动脉、基底动脉扩张和小脑前下动脉。所有NVC患者均接受了手术治疗，只有3例患者出现疼痛复发（p=0.029）。Kaplan-Meier生存试验比较了手术类型（PBC或MD）、复发时间（以月为单位）和复发情况，如图1所示。

Complications

Two patients had complications after MD: an extradural hematoma and a transitory peripheral facial palsy. No complication was observed after percutaneous balloon Demographic rate compression.

并发症

两名患者在MD后出现并发症：硬膜外血肿和短暂性周围性面瘫。经皮球囊扩张术后未观察到并发症。

DISCUSSION

We sought to compare PCB and MD for the treatment of TN in the terms of response to treatment and its longevity. After surgical treatment of this condition, a fairly large spectrum of potential outcomes exists from being completely pain-free and off of medication to no improvement, or, on rare occasions, worsening of these debilitating pain attacks.

讨论

我们试图比较PCB和MD治疗TN的疗效和维持时间。手术治疗之后，患者临床情况差异巨大，从完全无痛和停止药物治疗到没有任何改善，甚至极为少见的情况下，这些折磨人的疼痛发作还会进一步恶化。

Although vascular compression of the TN root entry zone is widely accepted as TN etiology, it fails to explain why some patients have TN without an identifiable NVC, as the main believed factor for proper decompression is the correct exposure of the root entrance zone. This is an important consideration, as patients who had NVC in the MRI, in our practice, had a lower recurrence rate. However, it should be noted that even patients without identifiable NVC on the MRI could still appreciate complete resolution of symptomatology after surgical procedures. Other negative factors that may influence recurrence are type II TN, disease duration, gender (female), bilateral involvement and multiple sclerosis.

尽管血管压迫三叉神经根部入髓区被广泛认为是TN病因，但它不能解释为什么有些患者患有TN而没有可识别的NVC，因为充分减压的先决条件是根部入口区的良好暴露。这是一个重要的考虑因素，因为在我们临床上，MRI中有NVC的患者复发率较低。然而，需要注意的是，即使MRI上没有可识别的NVC的患者，在手术后症状仍能得到完全缓解。其他可能影响复发的负面因素包括II型TN、病程、性别（女性）、双侧受累和合并多发性硬化。