The Long-Term Outcome Predictors of Pure Microvascular Decompression for Primary Trigeminal Neuralgia
The Long-Term Outcome Predictors of Pure Microvascular Decompression for Primary Trigeminal Neuralgia
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单纯微血管减压治疗原发性三叉神经痛的长期结果预测因素
DOI：
10.1016/j.wneu.2012.01.040
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发表时间：
2013-05-01
影响因子：
2
通讯作者：
Fang, Yuan
中科院分区：
文献类型：
--
作者：
Zhang, Heng;Lei, Ding;Fang, Yuan
目的：本研究旨在为单纯微血管减压（MVD）治疗原发性三叉神经痛（TN）的疗效和安全性提供可信和可比性的证据，并探讨术后长期预后良好的可能预后因素。方法：采用前瞻性队列研究，纳入符合原发性TN（包括典型和非典型）诊断标准的患者。队列患者接受纯MVD，然后由独立的神经科医生随访。采用logistic回归分析可能影响预后的因素。结果：从2001年1月至2005年11月，所有154例原发性TN患者（98例典型，56例不典型）均行单纯MVD。中位随访5.6年（5年内随访10例）。总的原发性TN的初始和5年完全无疼痛（巴罗神经学研究所疼痛评分，I）率分别为84%和72%，典型TN为87%和80%，非典型TN为79%和54%。5年Kaplan-Meier生存曲线显示不同组（典型TN与非典型TN）的长期结局不同。典型症状（优势比[OR]， 2.776）、术前磁共振提示血管受压（OR, 2.950）、术中发现明显血管受压（OR, 3.219）对长期非药物镇痛有积极作用。结论：这是一项纯MVD的前瞻性队列研究，证实了原发性TN手术的长期有效性和安全性。症状典型、磁共振阳性或明显血管受压的患者可能具有较好的长期预后。
OBJECTIVE: The aim of this study is to provide credible and comparable evidence on the efficacy and safety of pure microvascular decompression (MVD) for primary trigeminal neuralgia (TN), and also to find out the possible prognostic factors of excellent long-term outcome after the surgery.METHODS: A prospective cohort study was conducted, involving the patients who met the diagnostic criteria of primary TN (both typical and atypical). The cohort patients underwent pure MVD, and then were followed up by independent neurologists. The possible prognostic factors were analyzed by the logistic method.RESULTS: All 154 consecutive primary TN patients (98 typical, 56 atypical) underwent pure MVD from January 2001 to November 2005. The patients were followed up for median 5.6 years (10 lost in 5 years). Respective initial and 5-year's complete pain-free without medication (Barrow Neurological Institute pain score, I) rates were 84% and 72% for total primary TN, 87% and 80% for typical TN, and 79% and 54% for atypical TN. The Kaplan-Meier survival curves of 5 years demonstrated different long-term outcomes in different groups (typical TN vs. atypical TN). The typical symptoms (odds ratio [OR], 2.776), preoperative magnetic resonance indicating vessel compression (OR, 2.950), and obvious vessel compression found during operation (OR, 3.219) were proved to have a positive effect on long-term pain relief without medication.CONCLUSIONS: This is a perspective cohort study of pure MVD, which confirms the long-term effectiveness and safety of the surgery for primary TN. Patients with typical symptoms, positive magnetic resonance findings, or obvious vessel compressions might have better long-term prognosis.