Актуальні питання тригемінальних невралгій компресійного генезу. Результати хірургічного лікування з урахуванням впливу ятрогеній

Objective. To study the results of surgical treatment of classical and symptomatic trigeminal prosopalgias of compressive origin; to define the influence of iatrogenias and thus to improve the treatment provided for this cohort of patients.Materials and methods. Retrospective case series assay of 43 patients with trigeminal neuralgia of compressive origin was performed. The groups were formed regarding the sequence of treatment procedures. Group 1 included 15 patients with TN (3 patients with symptomatic TN and 12 persons with classic TN) who had undergone trigeminal nerve decompression as a primary measure. Group 2 consisted of 28 patients with TN (5 symptomatic and 23 classic) operated after destructive procedures performed previously.Results. Treatment outcomes were significantly worse in the 2nd group where destructive procedures were primary treatment options. Mean BNI PS on the 1st postoperative day were 1.2 vs 2.2 for groups 1 and 2, respectively (Р=0.01; 95% CI 0.25–1.78). At one-year of follow-up period the parameters were 1.13 vs 2.43 (P=0.0006; 95% CI 0.59–2). Average BNI NS score after one year was significantly worse in group 2 — 2.43 vs 1.27 in group 1 (P < 0.0001; 95% CI 0.67–1.65). 100% of group 2 and only 27% of group 1 had clinically significant neuropathy at one-year follow-up period after surgery with RR=3.75 (P=0.002; 95% CI 1.62–8.68).Conclusions. We suggest that destructive procedures as a primary measure for treatment of trigeminal neuralgias of compressive origin lead to worse long-term outcomes and reduce effectiveness of reconstructive technique of microsurgical decompression option.