Surgical treatment of primary trigeminal neuralgia by MVD or MVD + PSR

Abstract

Objective To explore the technique and effectiveness of microvascular decompression (MVD) or microvascular decompression + partial sensory rhizotomy (PSR) on the treatment of primary trigeminal neuralgia (TN).Methods 210 TN patients undergoing posterior fossa craniotomies for TN were retrospectively studied,among which there're 142 cases underwent MVD and the other 68 cases underwent MVD + PSR.Results Of the MVD group,pain vanished in 128(90.1％ ),obviously relieved in 9,and a total of 137(96.5％ ) cases were profited from MVD after operation.In the 82 cases with a follow-up more than 2 years,pain vanished in 74,pain sometime occurred in 5 which could be relieved by oral medicine (carbamazepine),the last 3 cases could not be controlled effectively by medicine.Of the MVD + PSR group,pain completely vanished in 67 cases,not changed in 1 case.In the 47 cases with a follow-up more than 2 years,pain sometime occurred in 2 which could be relieved by carbamazepine,the others were completely pain - free.The short - term pain - free rate in MVD + PSR group (98.5％ ) was obviously higher than the MVD group (90.1％ ),P ＜ 0.05.After a follow - up more than 2 years,the former was still higher than the later in the rate of 95.7％ and 90.1％ respectively,but there was no significant difference in statistics.Conclusions MVD + PSR was obviously superior to MVD in completely eliminating pain in short -term period after operation,the former still has a higher pain- free rate than the later in two years after operation,however,longer pain -free rate need even longer time to follow up;identifying the responsible vascular exactly and handling it reasonably were the key to both groups; there are both merits and shortcomings in MVD or MVD + PSR,so how to choose a more suitable surgical method depends on the findings in operation,the patient's own opinion and conditions should also be considered prudently before operation. Key words: Trigeminal neuralgia ; Microvascular decompression ; Sensory rhizotomy ;