Effect analysis of microvascular decompression for patients with trigeminal neuralgia caused by vertebrobasilar dolichectasia / 中国脑血管病杂志

ABSTRACT

Objective To investigate the safety and efficacy of microvascular decompression for patients with trigeminal neuralgia caused by vertebrobasilar dolichectasia ( VBD). Methods From April 2013 to August 2016, the clinical data of 13 consecutive patients with trigeminal neuralgia caused by VBD and treated with microvascular decompression at the Department of Neurosurgery,the 174th Hospital of PLA (n = 2) and the Department of Neurosurgery, Xiamen Humanity Hospital (n = 11) were enrolled retrospectively. Among them,4 were females and 9 were males,aged from 37 to 72 (mean 59 ± 10) years; the duration of the disease was 3-12 months,with a median of 36.0 (9.5,54.0) months; 1 patient was complicated with cerebral infarction before operation, 1 had transient ischemic attack;9 patients were complicated with hypertension,2 had diabetes, and 1 had coronary heart disease; 10 were treated with carbamazepine before operation, and 2 were treated with radiofrequency before operation; pain was mainly distributed in the second and third branches of trigeminal nerve. Preoperative and postoperative scores were assessed using the Baro Nervous Institute ( BNI) pain grading; preoperative head MRI was performed (including three-dimensional time of flight sequence) in order to confirm the diagnosis. Clinical follow-up was performed by outpatient and telephone after operation. Results (1) Preoperative BNI pain grading in 13 patients; grade IV in 4 cases and grade V in 9 cases. Both MRI and intraoperative findings were consistent with VBD characteristics,and the trigeminal nerve was significantly displaced by pressure. The distribution of guilty vessels was 6 cases in basilar artery,3 in basilar artery + superior cerebellar artery,and 4 in vertebral artery. Twelve patients were treated with microvascular decompression alone,and 1 was treated with microvascular decompression + selective partial posterior rhizotomy (SPPR). (2) All 13 patients completed clinical follow-up. The follow-up period ranged from 24 to 64 months, mean 48 ± 13 months. All 13 patients were effective immediately after operation (BNI grade I ) ,including ipsilateral hearing loss in 1 case, recurrence 1 year after operation in 1 case ( BNI grade HI) ,and recurrence in 1 case 3 years after operation (BNI grade M). Eleven patients were effective during the foUowed-up (BNI grade I ). Conclusions Microvascular decompression has a short-term curative effect for trigeminal neuralgia caused by VBD. Its safety is better,but because of the small sample size and VBD is a chronic progressive disease,its long-term efficacy needs further observation.