Comparative analysis between microvascular decompression and non-surgical treatment for senile idiopathic trigeminal neuralgia

Abstract

Objective To compare the efficacy and safety of microvascular decompression (MVD) and non-surgical treatment for treating senile idiopathic trigeminal neuralgia (ITN).  Methods A total of 133 patients older than 75 years with ITN respectively received MVD (N = 80) and non-surgical treatments (N = 53) such as pulse radiofrequency in 38 cases, stereotactic gamma knife radiotherapy in 10 cases, and acupuncture and moxibustion in 5 cases. McGill Pain Questionnaire (MPQ) was used to evaluate the degree of pain improvement. World Health Organization Quality of Life Scale-100 (WHOQoL-100) was used to evaluate life quality. Postoperative complications were recorded, including facial blunt sensation, headache, nausea and vomiting, pneumonia, intracranial infection, cerebrospinal fluid (CSF) leakage, deep venous thrombosis, incomplete facial paralysis, hearing loss and dyskinesia.  Results In MVD group, 79 cases (98.75%) had complete pain relief and one case (1.25%) had partial pain relief after operation. There were 8 cases (15.09% ) with complete pain relief, 33 cases (62.26% ) with partial pain relief, and 12 cases (22.64% ) without pain relief in non-surgical treatment group. The difference between 2 groups was statistically significant (χ² = 84.241, P = 0.000). After 55.80 (35.74, 63.48) months follow-up, the recurrence rate of MVD group was significantly lower than that of non-surgical treatment group [8.75% (7/80) vs. 35.85% (19/53); χ²= 16.558, P = 0.000]. The life quality of MVD group was better than that of non-surgical treatment group [WHOQoL-100 (27.82 ± 2.10) score vs. (22.19 ± 7.22) score; t = 1.202, P = 0.039]. The occurrence of postoperative complications such as facial blunt sensation, headache, nausea and vomiting were high in both groups, while the occurrence of pneumonia, intracranial infection, CSF leakage, deep venous thrombosis, incomplete facial paralysis, hearing loss and dyskinesia were rare in both groups. No case was dead. The incidence of facial blunt sensation in MVD group was significantly lower than that in non-surgical treatment group [8.75% (7/80) vs. 86.79% (46/53); χ² = 81.005, P = 0.000]. Conclusions MVD is safe and effective in the treatment of senile ITN, so it is suggested that MVD should be the first choice for patients with ITN, unless they cannot tolerate general anesthesia.

DOI: 10.3969/j.issn.1672-6731.2018.10.004