微血管减压术治疗三叉神经痛研究进展

Research Progress in Microvascular Decompression for Trigeminal Neuralgia

摘要: 目的：综述微血管减压术(MVD)治疗三叉神经痛的研究进展，明确其疗效、影响因素及优化方向。方法：通过分析临床研究数据，比较MVD与其他疗法(药物、射频热凝、微球囊压迫、伽玛刀)的疗效差异；总结患者因素(年龄、病程)、手术技术(垫棉放置、责任血管判定)及影像学评估(MRTA序列)对预后的影响；评估技术创新(机器人辅助、AI预测、3D外窥镜)的应用潜力。结果：MVD作为一线根治性方案，总有效率 > 90% (老年患者达97.1%)，15年长期缓解率75%，复发率仅4.76%。但术后并发症发生率约20% (脑脊液漏3.7%~6.1%、听力损失4.17%~6.77%)，9%患者出现复发。疗效对比显示：MVD显著优于药物 (耐受性差)、射频热凝(并发症47.62%)及伽玛刀(老年患者1个月缓解率仅37.9%)；微球囊压迫虽费用低，但面部麻木发生率高达45.76%。影像学与AI技术(如MRTA序列、神经网络预测模型)可精准指导手术，提升安全性。结论：MVD通过解除神经血管压迫实现病因治疗，疗效与安全性俱佳，但仍需优化手术策略以降低并发症及复发风险。未来需整合机器人辅助、个体化垫棉设计及增强现实导航等技术，推动精准化、微创化发展。

Abstract: Objective: To review the research progress of microvascular decompression (MVD) in treating trigeminal neuralgia, clarifying its efficacy, influencing factors, and optimization directions. Methods: By analyzing clinical research data, we compared the efficacy differences between MVD and other therapies (medication, radiofrequency thermocoagulation, microballoon compression, Gamma Knife); summarized the impact of patient factors (age, disease duration), surgical techniques (Teflon padding placement, identification of offending vessels), and imaging assessments (MRTA sequences) on prognosis; and evaluated the application potential of technological innovations (robot-assisted surgery, AI prediction, 3D exoscopes). Results: As a first-line curative treatment, MVD demonstrates an overall efficacy rate > 90% (reaching 97.1% in elderly patients), with a 75% long-term remission rate over 15 years and a recurrence rate of only 4.76%. However, postoperative complication rates are approximately 20% (cerebrospinal fluid leakage: 3.7%~6.1%; hearing loss: 4.17%~6.77%), and recurrence occurs in 9% of patients. Efficacy comparisons revealed that MVD significantly outperforms medication (poor tolerance), radiofrequency thermocoagulation (complication rate 47.62%), and Gamma Knife (only 37.9% one-month remission rate in elderly patients). Although microballoon compression has lower costs, it carries a high incidence of facial numbness (45.76%). Imaging and AI technologies (such as MRTA sequences and neural network prediction models) can precisely guide surgery and enhance safety. Conclusion: MVD addresses the etiology by relieving neurovascular compression, offering excellent efficacy and safety. However, surgical strategies still need optimization to reduce complication and recurrence risks. Future efforts should integrate technologies like robot assistance, personalized Teflon padding design, and augmented reality navigation to advance precision and minimally invasive development.