A proposal for standardized analysis of the results of microvascular decompression for trigeminal neuralgia and hemifacial spasm
A proposal for standardized analysis of the results of microvascular decompression for trigeminal neuralgia and hemifacial spasm
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DOI：
10.1007/s00701-012-1277-5
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发表时间：
2012-05-01
影响因子：
2.4
通讯作者：
Yamakami, Iwao
中科院分区：
文献类型：
--
作者：
Kondo, Akinori;Date, Isao;Yamakami, Iwao
本研究的目的是通过结合症状治愈率和并发症发生率来评估和分析微血管减压术(MVD)的总体结果。针对三叉神经痛(TN)和面肌痉挛(HFS)患者，提出了一种新的用于从MVD获得客观手术结果的新的评分系统，以标准化的方式使用一致的标准记录治疗结果。手术结果合并并发症来自于对近年来接受三叉神经痛或面肌痉挛手术且术后随访1年以上的患者的问卷调查(TN患者54例，HFS患者81例)，当手术结果完全缓解时，手术疗效(E)被评为E-0，但当术后仍有中度症状时，评分为E-2。术后未见并发症时，并发症评分(C)为C-0，如果有麻烦的并发症，则评分为C-2。此外，通过结合E和C分数来判断对结果(T)的总体评价。例如，当E为0，C为C-2时，总评分为T-2，诊断为公平，问卷应答率为80.7%(109/135)。使用我们的新评分系统对手术数据进行评估和分析。对收集的数据进行分析发现，TN的T-0转归为70%(35/50)，T-1转归为24%(12/50)，T-2转归为6%(3/50)，而在HFS，T0为61%(36/59)，T1为27.1%(16/59)，T2为6.8%(4/59)，T3为5.1%(3/59)，应结合症状治愈率和并发症发生率来评价和分析MVD的总体结果。这一新的评分系统可以更客观地分析MVD术后的结果。采用这一评分系统客观地判断TN和HFS的治疗结果，个别外科医生可以将自己的整体手术结果与其他机构的结果进行比较。MVD的比较结果也可以提供给考虑治疗的患者，以便在高质量证据的基础上做出明智的决定。
The purpose of this study was to evaluate and analyze overall postoperative results from microvascular decompression (MVD) by combining the cure rate of symptoms with the complication rate. A new scoring system for obtaining objective surgical results from MVD for trigeminal neuralgia (TN) and hemifacial spasm (HFS) is proposed to document treatment results using consistent criteria in a standardized manner.Surgical results combining complications , if any, were obtained from a questionnaire sent to patients who had undergone surgery for TN or HFS in recent years and had been followed-up for more than 1 year after surgery (TN patients, n = 54; HFS patients, n = 81) When surgical outcome is complete resolution of symptoms, the efficacy of surgery (E) is designated E-0, but when moderate symptoms are still persist postoperatively, the score is designated E-2. When no complications are seen after surgery, the complication score (C) is C-0, while the score is C-2 if troublesome complications remain. In addition, total evaluation of the results (T) is judged by combining the E and C scores. For example, when E is 0, and C is C-2, the total evaluation is scored as T-2, which is diagnosed as fair.The response rate of the questionnaire was 80.7% (109/135). Overall surgical data were evaluated and analyzed using our new scoring system. Analysis of the collected data revealed an outcome of T-0 was 70% (35/50 patients) and T-1 was 24% (12/50) and T-2 was 6% (3/50) in TN, whereas in HFS, T-0 was 61% (36/59) and T-1 was 27.1% (16/59) and T-2 was 6.8% (4/59) and T-3 was 5.1% (3/59).The total results of MVD should be evaluated and analyzed by combining the cure rate of symptoms together with the complication rate. This new scoring system could allow much more objective analysis of the results of following MVD. Adopting this scoring system to objectively judge treatment results for TN and HFS, individual surgeons can compare their own overall surgical results with those of other institutes. Comparative results of MVD can also be provided to patients considering therapy to allow informed decision-making on the basis of good quality evidence.