Discuss The Choice Of Surgical Treatment Plan For Secondary Trigeminal Neuralgia

Objective:To discuss the choice of surgical treatment for secondary trigeminal neuralgia(STN),and to lay the foundation of formulating individualized surgical treatment for STN.Methods:The clinical and postoperative follow-up datum of 354 patients with STN admitted to our department,Liaoning Provincial People’s Hospital.from February 2004 to September 2019 were retrospected systematically.Our department adopts two surgical treatment options:retrosigmoid approach of resecting cerebellopontine angle(CPA)tumor;percutaneous balloon compression(PBC).There were 247 operations of CPA tumor by the retrosigmoid approach,and 117 operations by PBC(5 patients underwent craniotomy after PBC because of the pain recurrence,and 5 patients underwent PBC after craniotomy because of no pain relief),and then the clinical relevant factors and therapeutic effect of the two groups were analyzed.Results:Microsurgery group:209 cases got total tumor resection,38 cases got subtotal resection,12 cases underwent microvascular decompression at the same time;9 cases had serious postoperative complications;Follow-up period was from 16 to 68 months,35 cases(14.17%)got recurrence after surgery,including 5 cases changed to PBC operation,2 cases re-craniotomized,5 cases changed to radiofrequency operation,3 cases changed to stereotactic radiotherapy,and others by conservative treatment methods;the postoperative "clinical cure rate" reached 93.52%,the total effective rate reached 97.17%,and the recurrence rate after 1 year was 2.83%(7/247),after 3 years was 7.69%(19/247)and after 5 years was 14.17%(35/247).PBC surgery group:In the PBC treatment group,117 patients underwent PBC surgery 151 times,of which 12 cases adopted PBC 2 times,8 cases adopted PBC 3 times and 2 cases adopted PBC 4 times;No one had serious postoperative complications;Follow-up period was from 14 to 62 months,43 cases(36.75%)got recurrence after surgery,including 22 cases cured by PBC again,5 cases changed to microsurgery,and 16 cases by conservative treatment methods;the postoperative "clinical cure rate" reached 93.16%,the total effective rate reached 98.29%,and the recurrence rate after 1 year was 5.98%(7/117),after 3 years was 17.95%(21/117)and after 5 years was 36.75%(43/117).There was no significant difference in the overall effective rate between the two groups(P>0.05),but the recurrence rate after surgery among them was statistically significant(P<0.01).Conclusion:The current surgical treatment options for STN include microsurgery(etiological treatment)and a series of destructive surgery(symptomatic treatment).The prognosis and risks of these surgical treatments are different.From the perspective of the patient,an individualized treatment plan is established based on the cause of trigeminal neuralgia and comprehensive consideration of the patient’s own subjective and objective factors.The most common cause of secondary trigeminal neuralgia is CPA tumors,the resection of CPA tumors can achieve the purpose of "radical cure" and should be the first choice for treatment,but some patients are willing to accept shorter Pain-free period to get lower risks of serious complications,so microsurgery is not suitable for every patient.The PBC is undoubtedly a boon for those patients who cannot tolerate microsurgery due to the patient’s own subjective and objective factors,and who are not satisfactory for the previous treatment effects.