Factors That May Affect Delayed Relief Of Trigeminal Neuralgia After Microneurosurgery And The Long-Term Outcomes Associated With Delayed Relief

OBJECTIVE: Microvascular decompression (MVD) combined with partial sensory rhizotomy (PSR) with the retrosigmoid approach has become the most effective surgical treatment for trigeminal neuralgia (TN). There is variability in the pain relief processes observed in postoperative patients. The purpose of this study was to investigate delayed relief (DR) and its predictors after MVD and/or PSR for the treatment of TN and study the long-term effects associated with DR. METHODS: Patients with primary TN who underwent MVD and/or PSR by the same surgeon at the China-Japan Friendship Hospital from March 2009 to December 2017 were included in the study, and all patients were followed for at least 1 year after the operation. DR was defined as follows: no changes in the Barrow Neurological Institute (BNI) score on the third day after surgery and a BNI score of I-II in the absence of any medication after a period of pain. Preoperative, intraoperative and postoperative differences were compared between the DR and non-DR groups, and the relationships between the various factors and DR was analyzed. RESULTS: A total of 105 patients, including 20 patients with DR (19%), 78 patients with non-DR (74%), and 7 patients without relief, were included in this study. The follow-up period ranged from 13 months to 118 months (average, 5.39 years/65 months). The duration of postoperative pain in the DR group was 3–365 days, with an average of 108 days. Statistical analysis found that no factor predicted the occurrence of DR, and the occurrence of postoperative DR did not affect the long-term effects observed in patients. CONCLUSION: DR did not affect the long-term effects after MVD and/or PSR. Therefore, it is recommended that patients should be monitored for approximately 3 months after MVD and/or PSR and then evaluated for surgical effects. No reoperations should be performed immediately.