术前医疗管理对经皮神经根切断术治疗三叉神经痛术后疗效的影响。

IF 3 2区医学 Q2 CLINICAL NEUROLOGY

Neurosurgical focus Pub Date : 2025-09-01 DOI:10.3171/2025.6.FOCUS25173

Megan Parker, Yuanxuan Xia, Melanie Alfonzo Horowitz, Divyaansh Raj, Saket Myneni, Sina Ahmadi, Praneethkumar Madhu, Anita Kalluri, Sumil K Nair, Sai Chandan Reddy, Michael Lim, Christopher Jackson, Judy Huang, Risheng Xu, Chetan Bettegowda

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引用次数: 0

摘要

目的：近一半的三叉神经痛（TN）患者最初的医疗治疗失败，患者将寻求手术治疗，无论是神经根切断术还是微血管减压术。术前医疗管理对根切断术后预后的影响尚不清楚。作者的目的是进一步评估这种关系。方法：在这项单中心、回顾性队列研究中，作者记录了他们所在机构（1995-2023）首次行根治术的TN患者的临床和人口统计学数据。采用单变量logistic回归和Cox回归分析来评估术前止痛药的数量和持续时间与术后结局（包括疼痛改善、无药物缓解和疼痛复发时间）之间的关系。结果：413例患者符合纳入标准（平均年龄62.6±15.7岁，女性63.0%）。TN术前使用止痛药的平均时间为57.0±73.1个月。在就诊时，85.5%的患者服用≥1种疼痛药物治疗TN，其中抗惊厥药是最常用的处方（78.7%）。术后，75.3%的患者疼痛改善，14.3%的患者疼痛缓解。在整个队列中，复发的中位时间为8.6 （95% CI 6.2-11.0）个月，术后TN疼痛改善的患者为12.8 （95% CI 8.8-16.7）个月，无需药物治疗的疼痛缓解患者为36.0 （95% CI 12.7-59.3）个月。术前使用止痛药的时间、尝试止痛药的数量、神经外科就诊时使用止痛药的数量和术后结果之间没有显著的关联。结论：虽然早期神经外科转诊对讨论治疗方案很有价值，但作者的研究结果表明，长期用药并不会降低神经根切断术缓解TN症状的有效性。

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Impact of preoperative medical management on postoperative outcomes after index percutaneous rhizotomy for trigeminal neuralgia.

Objective: Initial medical management fails in nearly half of patients with trigeminal neuralgia (TN), and patients will seek surgical management with either rhizotomy or microvascular decompression. The impact of preoperative medical management on post-rhizotomy outcomes is unclear. The authors aimed to further evaluate this relationship.

Methods: In this single-center, retrospective cohort study, the authors recorded clinical and demographic data for patients with TN who underwent first-time rhizotomy at their institution (1995-2023). Univariate logistic regression and Cox regression analyses were used to evaluate associations between the number and duration of preoperative pain medications with postoperative outcomes, including pain improvement, medication-free remission, and time to pain recurrence.

Results: A total of 413 patients met inclusion criteria (mean age 62.6 ± 15.7 years, 63.0% female). The mean time on preoperative pain medications for TN was 57.0 ± 73.1 months. At the time of presentation, 85.5% of patients were taking ≥ 1 pain medication for TN, with anticonvulsants being the most commonly prescribed (78.7%). Postoperatively, 75.3% experienced pain improvement and 14.3% achieved remission. The median time to recurrence was 8.6 (95% CI 6.2-11.0) months among the entire cohort, 12.8 (95% CI 8.8-16.7) months for patients who had postoperative improvement in TN pain, and 36.0 (95% CI 12.7-59.3) months for patients who achieved pain remission not requiring medication. There were no significant associations between time on preoperative pain medications, number of pain medications tried, number of pain medications at presentation to neurosurgery, and postoperative outcomes.

Conclusions: While early neurosurgical referral is valuable for discussing treatment options, the authors' findings suggest that prolonged medication use does not diminish the effectiveness of rhizotomy in relieving TN symptoms.

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