Analysis On The Effect Of Microvascular Decompression In Different Vascular For Primary Trigeminal Neuralgia

Objective:Evaluation of the effect of microvascular decompression in primary trigeminal neuralgia and analysis of the relationship between the offending vessels types and the effect of microvascular decompression.Method:We retrospectively analyzed 63 cases of primary trigeminal neuralgia patients underwent microvascular decompression treatment during February 2014 to December 2016 in functional neurosurgery department of Shanghai blue cross brain hospital,all the patients were performed trigeminal nerve MRTA scan and head CT scan,with the exception of secondary causes,the trigeminal nerve cistern segment needs to be exposed during operation,range from Meckel's cavity entrance to the root entry zone(REZ),according to the imaging data with which can be seen during operation,proven the offending vessels,eliminate 1 case(did not find responsibility vascular),62cases were divided into three groups according to their vascular types:cerebellar arterial compression group(offending vessels were superior cerebellar artery or anterior inferior cerebellar artery)include 45 cases;combined arteriovenous compression group include 17 cases;venous compression group include 4 cases.Release the responsible vessels that compress the trigeminal nerve,choosing different decompression methods according to vasclar types.The recovery of facial pain was divided into:1.Heal:the symptoms of facial pain disappeared completely,no facial pain was found at the end of follow-up;2.Improvement:the symptoms of facial pain disappeared basically or occasionally with slight pain.No need to drug therapy;3.Invalid:postoperative pain did not improve.observe and track the effect and complications of patients,and conduct statistical analysis.Results:All cases were observed and followed up for at least 12 months,cured 50 cases(80.65%),improved in 6 cases(9.68%),invalid in 3 cases(4.83%),effective(cure and improving)56 cases,the total effective rate was90.32%,effective 43 cases of cerebellar artery oppression group(95.56%,43/45),combined arteriovenous compression set of 10 cases(76.92%,10/13),venous compression set of 3 cases(75%,3/4),the effective rates between the three groups have no statistical significance(?~2=5.071,P=0.079).Cure of 50cases(80.65%),cerebellar artery compression group 40 cases(88.89%,40/43),combined arteriovenous compression set of 8 cases(61.54%,8/13),venous compression set of 2 cases(50%,2/4),the difference of cure rate between arterial compression group and arteriovenous compression group(?~2=1.845,P<0.001),the difference of effective rate between arterial compression group and arteriovenous compression group(?~2=1.329,P<0.001),the difference of cure rate between three groups was statistically significant(?~2=4.287,P=0.042).There were 3 cases(4.84%)with recurrence,including 1 case(2.22%)in the cerebellar arterial compression group and 2 cases(15.38%)in the combined arteriovenous compression group.Complications included 2 cases of postoperative facial numbness,1 case of tinnitus,and 1 case of upper lip herpes zoster.Conclusion:1.Vascular compression of trigeminal nerve is one of the important causes of primary trigeminal neuralgia.Microvascular decompression is an effective method to treat primary trigeminal neuralgia.2.The decompression effect of arterial responsibility vessel is the best,the mixed type of artery and vein is the second,and the effect of venous responsibility vessel is the worst,because the number of cases in this group is less,the conclusion needs to be further verified by more cases in multi centers.