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Resumen Introducción: La descompresión microvascular (DMV) en la neuralgia trigeminal es una técnica quirúrgica cuyo objetivo es revertir la compresión a la que se ve someti do un nervio por una estructura vascular. El objetivo de este estudio fue realizar una comparación directa entre la descompresión microvascular endoscópica (DMV-E) y la misma a través del uso del microscopio (DMV-M) en el tratamiento de la neuralgia del trigémino. Métodos: Se realizó un estudio de cohorte retrospec tivo de pacientes operados de neuralgia de trigémino, por un mismo cirujano, entre 2015 y 2021 en nuestra institución, tanto por técnica microquirúrgica como endoscópica. Resultados: Se obtuvieron un total de 31 pacientes divididos en dos grupos: Grupo M correspondiente a 15 (49%) pacientes abordados con técnica microscópica y Grupo E, con 16 (51%) pacientes intervenidos con técnica endoscópica. Se identificaron diferencias en el tamaño de la cra niectomía, más pequeña en el grupo E (2.50 cm vs 3.70 cm grupo M); y en el tiempo de internación, de 2.43 días en el grupo E vs. 4.46 días en el grupo M. El tiempo de cirugía fue similar para ambas técnicas quirúrgicas La principal compresión fue dada por la arteria ce rebelosa superior (ACS) en ambos grupos. Todos los pacientes presentaron mejoría del Barrow Neurological Institute Pain Intensity Score (BNI) en el postoperatorio en ambos grupos. Discusión: La DMV-E constituye una alternativa qui rúrgica interesante a la ya conocida DMV-M para el tratamiento de la neuralgia trigeminal, por requerir menores dimensiones en la incisión cutánea y tamaño de la craniectomía, acortando el tiempo de internación, lo cual no solo implica un beneficio para el paciente, sino que también representa menor costo de internación.
Abstract Introduction: Trigeminal neuralgia is a highly invali dating pathology, whose natural course has been modi fied thanks to decompressive microvascular surgery. The intervention can be carried out either with a microscope or via an endoscopic technique. Our goal was to compare these two techniques for the treatment of this complex pathology. Methods: Retrospective, analytical study of a cohort of patients treated by a single surgeon at our institution, in the period between 2015 and 2021. Results: We identified 31 patients and divided them into two groups: 15 (49%) treated using the microscopic technique (group M), and 16 (51%) exclusively via an endoscopic one (group E). Differences were observed between the means of the size of the craniectomy in group M (3.7 cm) compared to group E (2.5 cm); The mean length of hospital stay for patients in group E was shorter (4.46 days compared to that of patients in group M, whose hospital stay averaged 2.43 days). There were no differences between the two groups regarding the length of the procedure. In both groups, the predomi nant compression was due to the superior cerebellar artery (SCA). Pain outcomes were equivalent, with every patient in both groups having an improved postoperative Barrow Neurological Institute Pain Intensity Score (BNI). Discussion: Endoscopic microvascular decompression is an attractive option for the resolution of neurovas cular conflict as it provides functional results similar to the microscope technique, without requiring an exten sive craniectomy and associated to shorter in-hospital stay, which is beneficial for both the patient and the institution.
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Objective To explore the effect and experience of problem-based (PBL) teaching in neurosurgical clinical training and improve the quality of the neurosurgical clinical training. Methods 600 clinical medical students of Grade 2011 in their probation in our department of neurosurgery were chosen as the subjects of study and were randomly divided into the experimental (PBL, 15 groups, 20 people/group, over 300 people) and control groups (CBL+ LBL, 15 groups, 20 people/group, over 300 people). In experimental group, PBL which is a problem-based, student-centered and teacher-directed pedagogy was adopted. In control group, CBL (case-based learning) + LBL (lecture-based learning) were adopted. After probation, two groups of students had the unified test and assessed their teaching methods by questionnaire survey and at the same time, the questionnaire survey about PBL' impact on the various aspects was done only to experimental group students. SPSS 15.0 software was used to do statistical analysis and data were processed by description analysis, t test, Mann-Whitney U test and correlation analysis. Results The scores of theoretical knowledge and general ability in PBL group [(40.57 ±3.24), (41.23 ±4.56) individually] were higher than these in control group [(37.21 ±4.05), (36.51±4.11) individually]. The differences demonstrated statistically meanings. Through the surveys, the students in experimental group showed the high satisfaction (97.0%, n=291) in PBL teaching. Most of the students considered that their abilities of team cooperation (96.7%, n=290), and self-directed learning (92.7%, n=278) were improved by PBL teaching. The students in experimental group illustrated their attitudes in satisfaction of teaching; interests of clinical training, participation of teaching and understanding of knowledge were superior to the control group. The differences demonstrated statisti-cally meanings. Conclusion PBL teaching got a good effect in neurosurgical clinical training. This method, which improved students' participation and motivation of study and contributed to the training of medical students' comprehensive abilities, is suitable for modern neurosurgical clinical training.