Xin Zhang1, Ling Xu2, Hua Zhao1, Yin-Da Tang1, Jin Zhu1, Yan Yuan1, Ping Zhou1, Shi-Ting Li3. 1. Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China. 2. Department of Neurosurgery, Affiliated Hospital of Zunyi Medical College, Guizhou, China. 3. Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China. Electronic address: lishiting@xinhuamed.com.cn.
Abstract
BACKGROUND: Microvascular decompression (MVD) of the trigeminal nerve is the most effective treatment for trigeminal neuralgia (TN). However, many patients respond poorly to initial MVD. For these patients, redo MVD is commonly done. There has been no research regarding the effectiveness of nerve combing (NC) plus MVD in patients with TN and failed prior MVD. We compared the clinical outcome of NC plus MVD and simple redo MVD in patients with TN and failed prior MVD. METHODS: We performed a retrospective analysis of 148 patients with recurrent or persistent TN symptoms who underwent surgery between January 2007 and December 2015. Simple MVD was performed in 62 patients, and NC plus MVD was performed in 86 patients. RESULTS: For simple MVD, success rates at 1 day, 7 days, 1 month, 3 months, and 1 year after surgery all were approximately 80%. Success rates of NC plus MVD were significantly (P < 0.05) higher than success rates of simple MVD, by 17.02%, 18.64%, 16.47%, 17.21%, and 14.80% at 1 day, 7 days, 1 month, 3 months, and 1 year. The incidence rates of facial numbness in the simple MVD group were 48.39%, 45.16%, 36.67%, 16.95%, and 1.75% at 1 day, 7 days, 1 month, 3 months, and 1 year; the incidence rates in the NC plus MVD group were 60.47%, 55.81%, 48.24%, 21.69%, and 3.75% (P > 0.05). CONCLUSIONS: In patients with TN who failed prior MVD, NC plus MVD significantly improved the success rate of the operation compared with simple redo MVD. We obtained good short-term and long-term surgical outcomes with NC combined with MVD.
BACKGROUND: Microvascular decompression (MVD) of the trigeminal nerve is the most effective treatment for trigeminal neuralgia (TN). However, many patients respond poorly to initial MVD. For these patients, redo MVD is commonly done. There has been no research regarding the effectiveness of nerve combing (NC) plus MVD in patients with TN and failed prior MVD. We compared the clinical outcome of NC plus MVD and simple redo MVD in patients with TN and failed prior MVD. METHODS: We performed a retrospective analysis of 148 patients with recurrent or persistent TN symptoms who underwent surgery between January 2007 and December 2015. Simple MVD was performed in 62 patients, and NC plus MVD was performed in 86 patients. RESULTS: For simple MVD, success rates at 1 day, 7 days, 1 month, 3 months, and 1 year after surgery all were approximately 80%. Success rates of NC plus MVD were significantly (P < 0.05) higher than success rates of simple MVD, by 17.02%, 18.64%, 16.47%, 17.21%, and 14.80% at 1 day, 7 days, 1 month, 3 months, and 1 year. The incidence rates of facial numbness in the simple MVD group were 48.39%, 45.16%, 36.67%, 16.95%, and 1.75% at 1 day, 7 days, 1 month, 3 months, and 1 year; the incidence rates in the NC plus MVD group were 60.47%, 55.81%, 48.24%, 21.69%, and 3.75% (P > 0.05). CONCLUSIONS: In patients with TN who failed prior MVD, NC plus MVD significantly improved the success rate of the operation compared with simple redo MVD. We obtained good short-term and long-term surgical outcomes with NC combined with MVD.