Abstract:

Objective  To analyze the efficacy and safety of microvascular decompression (MVD) for the treatment of elderly patients with trigeminal neuralgia (TN). Methods  A total of 286 primary TN patients [50 cases of age ≥ 70 years (older group) and 236 cases of age < 70 years (younger group)] underwent MVD via suboccipital sigmoid approach. Postoperative complications were recorded, including facial numbness of operation side, hearing loss of operation side, cerebrospinal fluid (CSF) leakage, poor wound healing, intracranial infection and hydrocephalus. Barrow Neurological Institute (BNI) grade was used to evaluate the relief of TN before and after surgery and during the follow-up. The recurrence rate during follow-up period was recorded.  Results  Of all cases, 36 (12.59%) presented with postoperative complications, including 18 cases (6.29%) of facial numbness of operation side, 13 cases (4.55%) of hearing loss of operation side, one case (0.35%) of CSF leakage, one case (0.35%) of poor wound healing, 2 cases (0.70% ) of intracranial infection and one case (0.35% ) of hydrocephalus. In those 36 cases, 29 cases (12.29% ) were in younger group and 7 cases (14% ) were in older group, and there was no significant difference between 2 groups (χ² = 0.110, P = 0.740). The mean follow-up period was 29.43 months. During the follow-up, 170 cases (78.70%) had complete pain relief (BNI gradeⅠ), 10 cases (4.63%) had partial pain relief (BNI gradeⅡ-Ⅲ), 14 cases (6.48%) had no pain relief (BNI grade Ⅳ-Ⅴ), and 22 (10.19%) recurred TN in 216 cases of the younger group; 35 cases (79.55%) had complete pain relief (BNI gradeⅠ), 2 cases (4.55%) had partial pain relief (BNI grade Ⅱ-Ⅲ), one case (2.27%) had no pain relief (BNI grade Ⅳ- Ⅴ), and 6 cases (13.64% ) recurred TN in 44 cases of the older group. There was no significant difference on prognosis between 2 groups (χ² = 1.530, P = 0.675). Kaplan-Meier curve showed the rate of complete pain relief was decreased with time.  Conclusions  Pure MVD for treating elderly patients with TN is safe and effective, without postoperative death or severe complications.

Key words: Trigeminal neuralgia, Microsurgery, Postoperative complications, Aged

摘要：

目的 探讨微血管减压术治疗老年三叉神经痛的有效性和安全性。方法 共286 例原发性三叉神经痛患者［≥ 70 岁50 例（老龄组），< 70 岁236 例（低龄组）］均采用患侧枕下经乙状窦后入路行微血管减压术，记录术后并发症，包括术侧面部麻木感、术侧听力下降、脑脊液漏、手术切口愈合欠佳、颅内感染、脑积水；采用Barrow 神经病学研究所（BNI）三叉神经痛分级评价疼痛缓解；记录随访期间复发率。结果 286 例患者中36 例（12.59%）出现术后并发症，低龄组29 例（12.29%），老龄组7 例（14%），组间差异无统计学意义（χ² = 0.110，P = 0.740），为术侧面部轻度麻木感18 例（6.29%）、术侧听力下降13 例（4.55%）、脑脊液漏1 例（0.35%）、手术切口愈合欠佳1 例（0.35%）、颅内感染2 例（0.70%）和脑积水1 例（0.35%）。随访29.43 个月，随访的216 例低龄组患者中170 例（78.70%）疼痛完全缓解（BNI 分级Ⅰ级），10 例（4.63%）疼痛部分缓解（BNI 分级Ⅱ ~ Ⅲ级），14 例（6.48%）疼痛无缓解（BNI 分级Ⅳ ~ Ⅴ级），22 例（10.19%）复发；随访的44 例老龄组患者中35 例（79.55%）疼痛完全缓解（BNI 分级Ⅰ级），2 例（4.55%）疼痛部分缓解（BNI 分级Ⅱ ~ Ⅲ级），1 例（2.27%）疼痛无缓解（BNI 分级Ⅳ ~ Ⅴ级），6 例（13.64%）复发，组间预后差异无统计学意义（χ2 = 1.530，P = 0.675）。Kaplan-Meier 曲线显示，随着随访时间的延长，两组患者术后疼痛完全缓解率均逐渐下降。结论 单纯微血管减压术治疗老年三叉神经痛安全、有效，未出现死亡或神经功能障碍等严重并发症。

关键词: 三叉神经痛, 显微外科手术, 手术后并发症, 老年人