Individualized Treatment Of Trigeminal Neuralgia And Its Curative Effect

Objective: To analyze the efficacy of microvascular decompression(MVD)in different populations,and to determine the appropriate population for MVD.While,to analyze the efficacy of radiofrequency thermocoagulation(RFT)and percutaneous balloon compression(PBC).It aims to develop an effective personalized surgical treatment plan for patients with trigeminal neuralgia,and strive to maximize pain relief and improve the quality of life of patients.Materials and Methods: The data of patients with primary trigeminal neuralgia(PTN)who underwent surgical treatment in the Department of Neurosurgery of our hospital from January 2015 to December 2022 were retrospectively collected to explore the therapeutic effects of three different surgical methods: MVD,PBC and RFT.The pain relief,recurrence rate and complications were systematically analyzed.By comparing the efficacy,recurrence rate and complications of MVD in different populations,to determine whether different affected side,gender,age,course of disease,responsible blood vessels and involved nerve branches affect the therapeutic effect of MVD,as well as the average length of hospitalization,operation time,hospitalization cost and postoperative recovery days of different surgical procedures,in order to find the population suitable for MVD operation.And to provide alternative surgical therapy for patients who are not suitable for MVD.Results:A total of 250 PTN patients were collected in this study,including 207 patients who underwent MVD,32 patients who underwent RFT,and 11 patients who underwent PBC.Among the patients with PTN,the female was more than the male,accounting for58.00%.The number of patients on the right side was more,accounting for 56.40%.Most of the patients were involved in V2 and V3 branches,accounting for 89.60%.Among all the patients who underwent MVD,195 cases(94.20%)had complete or obvious relief of pain,9 cases(4.35%)had partial relief,and 3 cases(1.45%)had no effect.The overall effective rate was 98.55%.Among the 207 patients,12 patients had recurrence,and the recurrence rate was 5.80%.Complications occurred in 14 patients,and the overall incidence of complications was 6.76%.Among the patients who underwent RFT,22 cases(68.75%)had complete or obvious relief of pain,9 cases(28.13%)had partial relief,and 1 case(3.12%)had no effect.The overall effective rate was 96.88%,which was slightly worse than MVD,but the effect was still significant.However,the recurrence rate of RFT was higher,15.63%(5/32).While,postoperative complications of facial numbness occurred in all patients,including masticatory muscle weakness in 5 cases(15.63%),but the types of complications were few and all were relieved later.Among the patients who underwent PBC,8 cases(72.73%)had complete or obvious relief of pain,3 cases(27.28%)had partial relief,and the overall effective rate was 100.00%.However,PBC has just been carried out,and there are few cases and no follow-up information,which may not accurately reflect its efficacy.Similarly,postoperative complications of facial numbness occurred in all patients,including 2cases(18.18%)of masticatory muscle weakness,but they all resolved later.The results of MVD efficacy analysis in different populations showed that gender did not affect the effective rate and recurrence rate of MVD.The incidence of postoperative complications in women was higher than that in men(10.00%).Female patients may have diplopia,perioral herpes,intracranial infection,facial numbness and other complications after MVD,while male patients only have facial numbness and subcutaneous effusion.Age did not affect the postoperative efficacy of MVD,but the recurrence rate of MVD was higher than that in patients under 65 years old.There was no significant difference in the incidence of postoperative complications in patients with different ages.PBC and RFT were effective in the elderly.This study also found that there were differences in the efficacy of MVD in different responsible vessels.The results showed that the MVD in the superior cerebellar artery group was significantly better than that in the combined superior cerebellar artery group(P<0.05).This study also found that different side,course of disease,and trigeminal branch involvement did not affect the efficacy of MVD.Among the three surgical methods,MVD had the longest hospitalization time(13±2.38)days,the highest cost(32,741.52 ±3621.34)yuan,and the longest operation time(150±22.53)minutes.The postoperative recovery time of PBC and RFT was significantly shorter than that of MVD[(5±1.56)days vs.(3±1.63)days vs.(14±1.38)days].Conclusion:In conclusion,MVD,PBC and RFT can better relieve the pain symptoms of PTN,and are effective means for PTN after drug treatment is ineffective or drug tolerance occurs.MVD is undoubtedly the preferred surgical method for PTN patients with good physical condition and vascular compression.While,the surgical method should be comprehensively selected according to the patient’s condition.PBC or RFT is recommended for patients with more underlying diseases,old age and infirmity,stubborn recurrence and unable to undergo craniotomy.PBC and RFT have obvious advantages in length of hospital stay,hospitalization cost,operation time and postoperative recovery days.Therefore,it is necessary to comprehensively consider the patients’ own conditions,select appropriate surgical therapy,and develop effective personalized programs for patients with trigeminal neuralgia,in order to maximize pain relief and improve the quality of life of patients.