Margaret Tugend, Colby T Joncas, Yue-Fang Chang, Yanis Jaoui, Raymond F Sekula
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The predictive value of a tentative new scoring system was examined (scoring system B) and compared with scoring system A.</p><p><strong>Results: </strong>At a mean follow-up of 63 months, 282 patients (68.8%) were pain free without medications. Univariable analysis showed that age >45 years(χ2 = 6.26, df = 1, P = .012), TN type (χ2 = 53.16, df = 1, P < .0001), response to carbamazepine (χ2 = 6.65, df = 1, P = .010), and neurovascular compression (χ2 = 25.93, df = 1, P < .0001) all significantly predicted postoperative pain freedom without medication. Using scoring system A, a patient with a preoperative score of 3, 4, or 5 was, respectively, 2.05 (P = .114), 5.76 (95% CI 2.46-13.50, P < .0001), and 10.52 (95% CI 4.66-23.79, P < .0001) times more likely to attain long-term pain freedom without medication than a patient with a score of 0 or 1. Using scoring system B, a patient with a score of 3 or 4 was, respectively, 3.59 (95% CI 1.42-9.08, P = .007) and 8.68 (95% CI 3.42-22.05, P < .0001) times more likely to attain long-term pain freedom without medication than a patient with a score of 0 or 1.</p><p><strong>Conclusion: </strong>In a larger cohort of patients with longer term follow-up, both scoring systems A and B reliably predict long-term pain freedom after MVD for TN in this patient population and may be beneficial in selecting patients most likely to benefit from surgery.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Update and Evaluation of a Preoperative Scoring System to Predict Long-Term Outcomes After Microvascular Decompression in Trigeminal Neuralgia.\",\"authors\":\"Margaret Tugend, Colby T Joncas, Yue-Fang Chang, Yanis Jaoui, Raymond F Sekula\",\"doi\":\"10.1227/ons.0000000000001599\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Scoring systems attempting to predict long-term pain relief after microvascular decompression (MVD) for trigeminal neuralgia (TN) have been published previously. We compare the Panczykowski scoring system and a new scoring system, developed in response to published criticisms of previous scoring systems, in a larger cohort with longer term follow-up.</p><p><strong>Methods: </strong>In this retrospective cohort study, records from 410 patients undergoing MVD for TN were reviewed. Pain freedom after MVD was recorded, and Panczykowski scores (scoring system A) were calculated. Univariate logistic regression models were used to determine the relationship between clinical characteristics and pain freedom at follow-up. The predictive value of a tentative new scoring system was examined (scoring system B) and compared with scoring system A.</p><p><strong>Results: </strong>At a mean follow-up of 63 months, 282 patients (68.8%) were pain free without medications. Univariable analysis showed that age >45 years(χ2 = 6.26, df = 1, P = .012), TN type (χ2 = 53.16, df = 1, P < .0001), response to carbamazepine (χ2 = 6.65, df = 1, P = .010), and neurovascular compression (χ2 = 25.93, df = 1, P < .0001) all significantly predicted postoperative pain freedom without medication. Using scoring system A, a patient with a preoperative score of 3, 4, or 5 was, respectively, 2.05 (P = .114), 5.76 (95% CI 2.46-13.50, P < .0001), and 10.52 (95% CI 4.66-23.79, P < .0001) times more likely to attain long-term pain freedom without medication than a patient with a score of 0 or 1. Using scoring system B, a patient with a score of 3 or 4 was, respectively, 3.59 (95% CI 1.42-9.08, P = .007) and 8.68 (95% CI 3.42-22.05, P < .0001) times more likely to attain long-term pain freedom without medication than a patient with a score of 0 or 1.</p><p><strong>Conclusion: </strong>In a larger cohort of patients with longer term follow-up, both scoring systems A and B reliably predict long-term pain freedom after MVD for TN in this patient population and may be beneficial in selecting patients most likely to benefit from surgery.</p>\",\"PeriodicalId\":520730,\"journal\":{\"name\":\"Operative neurosurgery (Hagerstown, Md.)\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-05-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Operative neurosurgery (Hagerstown, Md.)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1227/ons.0000000000001599\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Operative neurosurgery (Hagerstown, Md.)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1227/ons.0000000000001599","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的：评分系统试图预测三叉神经痛（TN）微血管减压（MVD）后的长期疼痛缓解。我们比较了Panczykowski评分系统和一个新的评分系统，该评分系统是针对先前评分系统发表的批评而开发的，在一个更大的长期随访队列中。方法：在这项回顾性队列研究中，回顾了410例因TN接受MVD的患者的记录。记录MVD后疼痛解除情况，计算panchzykowski评分（评分系统A）。采用单变量logistic回归模型确定临床特征与随访时疼痛缓解之间的关系。研究了一种暂定的新评分系统（评分系统B）的预测价值，并与评分系统a进行了比较。结果：平均随访63个月，282例（68.8%）患者在无药物治疗的情况下疼痛消失。单变量分析显示，年龄（χ2 = 6.26, df = 1, P = 0.012）、TN类型（χ2 = 53.16, df = 1, P < 0.0001）、卡马西平疗效（χ2 = 6.65, df = 1, P = 0.010）、神经血管受压（χ2 = 25.93, df = 1, P < 0.0001）与术后无药物治疗疼痛均有显著相关性。使用评分系统A，术前评分为3、4或5分的患者在不服药的情况下获得长期疼痛缓解的可能性分别是评分为0或1分的患者的2.05 （P = 0.114）、5.76 （95% CI 2.46-13.50, P < 0.0001）和10.52 （95% CI 4.66-23.79, P < 0.0001）倍。使用评分系统B，得分为3或4的患者在不服药的情况下获得长期疼痛缓解的可能性分别是得分为0或1的患者的3.59 （95% CI 1.42-9.08, P = 0.007）和8.68 （95% CI 3.42-22.05, P < 0.0001）倍。结论：在一个更大的长期随访患者队列中，评分系统a和B可靠地预测了该患者群体中MVD后TN的长期疼痛缓解，并且可能有助于选择最有可能从手术中获益的患者。
Update and Evaluation of a Preoperative Scoring System to Predict Long-Term Outcomes After Microvascular Decompression in Trigeminal Neuralgia.
Background and objectives: Scoring systems attempting to predict long-term pain relief after microvascular decompression (MVD) for trigeminal neuralgia (TN) have been published previously. We compare the Panczykowski scoring system and a new scoring system, developed in response to published criticisms of previous scoring systems, in a larger cohort with longer term follow-up.
Methods: In this retrospective cohort study, records from 410 patients undergoing MVD for TN were reviewed. Pain freedom after MVD was recorded, and Panczykowski scores (scoring system A) were calculated. Univariate logistic regression models were used to determine the relationship between clinical characteristics and pain freedom at follow-up. The predictive value of a tentative new scoring system was examined (scoring system B) and compared with scoring system A.
Results: At a mean follow-up of 63 months, 282 patients (68.8%) were pain free without medications. Univariable analysis showed that age >45 years(χ2 = 6.26, df = 1, P = .012), TN type (χ2 = 53.16, df = 1, P < .0001), response to carbamazepine (χ2 = 6.65, df = 1, P = .010), and neurovascular compression (χ2 = 25.93, df = 1, P < .0001) all significantly predicted postoperative pain freedom without medication. Using scoring system A, a patient with a preoperative score of 3, 4, or 5 was, respectively, 2.05 (P = .114), 5.76 (95% CI 2.46-13.50, P < .0001), and 10.52 (95% CI 4.66-23.79, P < .0001) times more likely to attain long-term pain freedom without medication than a patient with a score of 0 or 1. Using scoring system B, a patient with a score of 3 or 4 was, respectively, 3.59 (95% CI 1.42-9.08, P = .007) and 8.68 (95% CI 3.42-22.05, P < .0001) times more likely to attain long-term pain freedom without medication than a patient with a score of 0 or 1.
Conclusion: In a larger cohort of patients with longer term follow-up, both scoring systems A and B reliably predict long-term pain freedom after MVD for TN in this patient population and may be beneficial in selecting patients most likely to benefit from surgery.
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