Individualized options for surgery and gamma knife treatment of trigeminal neuralgia

Li Xiaoyue; Liu Cuicui; Zhao Dongdong; Lu Bing; Chen Liang; Pan Haipeng; Feng Wen; He Yongsheng

doi:10.11850/j.issn.1009-122X.2024.01.004

Abstract：Objective To evaluate the efficacy and safety of microvascular decompression(MVD),MVD combined with partial sensory rhizotomy(PSR)and Gamma knife surgery(GKS)in the treatment of primary trigeminal neuralgia(PTN)and to explore the individualized surgical treatment of PTN.Methods The clinical data of 187 PTN patients were analyzed retrospectively.They were divided into MVD group,MVD+PSR group and GKS group according to the treatment.The follow-up time was greater than 1 year.The pain relief rate and the occurrence of complications were compared between the three groups.Results At the last follow-up,the rate of effective pain relief was 93.33%in MVD group,95.45%in MVD+PSR group and 90.00%in GKS group respectively,with no significant difference.The total pain-free rates were 73.33%in the MVD group,86.36%in the MVD+PSR group and 43.33%in the GKS group respectively,which was significantly higher in the MVD group and MVD+PSR group than in the GKS group(P<0.0167).The complication rate was significantly higher in the MVD+PSR group than in the GKS group and MVD group(P<0.0167).Conclusions ①Surgery and GKS are both effective treatments for PTN,and the pain relief efficiency is similar.②The complication rate after MVD and GKS treatment is low.Although the analgesic effect of MVD+PSR group is satisfactory,its complication rate is extremely high and satisfaction is low,so it is not recommended to be preferred.③MVD is preferred when there is clear neurovascular compression on preoperative imaging.④GKS is safety,can be recommended in the patients who have no definite neurovascular compression,are the aged,cannot tolerate surgery or refuse surgery.