Comparison of balloon compression and microvascular decompression in the treatment of primary trigeminal neuralgia
Objective:To compare the clinical efficacy of percutaneous balloon compression(PBC)and microvascular decompression(MVD)in the treatment of primary trigeminal neuralgia(PTN).Methods:Total of 119 patients with PTN who were hospitalized at Jiangxi Provincial People's Hospital from July 2018 to December 2020 were included.Among them,66 patients received MVD treatment,and 53 patients underwent PBC treatment.All patients were followed up for a minimum of 2 years.All the patients underwent 3.0 Tesla magnetic resonance imaging before surgery to obtain 3D time series of flight(3D-TOF).Three-dimensional(3D)reconstruction by 3DSlicer software was used to detect the level of compression.Based on the degree of compression,patients were divided into types Ⅰ,Ⅱ and Ⅲ.The postoperative COX proportional-hazards regression model of MVD and PBC included the degree of compression,gender,age,side,lesion location,diabetes mellitus,hypertension,and disease course.Receiver operating characteristic(ROC)curves were used to evaluate the correlation between risk factors and prognosis.Subgroup analysis of PTN patients was performed,and COX regression model and Kaplan-Meier(KM)curve were used for evaluating the prognosis.Finally,subgroup analysis was performed on PTN patients,and the prognostic results were evaluated based on the COX regression model and Kaplan-Meier curve.Results:In the MVD group,the immediate postoperative remission rate was 92.4%,the recurrence rate was 11.5%,and the overall response rate within 3 years was 81.8%.In the PBC group,the immediate postoperative remission rate was 96.2%,the recurrence rate was 21.6%,and the overall response rate within 3 years was 75.5%.Chi-square test showed no significant differences in immediate postoperative remission rate,recurrence rate,and overall remission rate within 3 years between the two groups.The multivariate COX regression model indicated that the degree of vascular compression significantly correlated with the prognosis of patients in the MVD group,whereas it showed no association with the prognosis of patients in the PBC group.Subgroup analysis of PTN patients was performed based on the degree of vascular compression.The COX regression model and Kaplan-Meier curve showed no significant difference in prognosis between MVD and PBC therapy in type I(no definite vascular compression)PTN patients,while patients treated with MVD had a better prognosis than those treated with PBC in type Ⅱ + Ⅲ(definite vascular compression)subgroups.Conclusion:For patients with type I PTN,there was no significant difference in therapeutic effect between PBC and MVD therapy.For patients with type Ⅱ + Ⅲ,those who underwent MVD treatment demonstrated a significantly better prognosis compared with those who received PBC treatment.The degree of vascular compression is an important factor in the selection of surgical methods for different patients.
percutaneous balloon compressionmicrovascular decompressiontypical trigeminal neuralgiadegree of vascular compressionoperative effect
NETL
NSTL
万方数据
维普
