Result 1: Number of patients and exclusion criteria
A total of 133 TN patients treated by surgery were admitted to the Affiliated Huai 'an First People's Hospital of Nanjing Medical University from January 2017 to December 2022. Sixteen individuals underwent MVD and were excluded from the study, Seven patients with preoperative cognitive impairment were excluded.while 94 underwent balloon compression. Of the 94 patients, 21 had postoperative cognitive dysfunction, 16 had transient cognitive impairment and mostly recovered within three days, 3 developed long-term cognitive dysfunction, and 3 completed functional magnetic resonance imaging (MRI) examinations after surgery, as shown in Fig. 1. Moreover, eight patients were treated with HBO after surgery.
Result 2: Baseline Characteristics Of The Patients
The average age of patients undergoing surgery for trigeminal dysmenorrhea was 64.9 years, with more women than men, and the average operative time was 48.9 minutes.Compared with patients who did not develop postoperative cognitive dysfunction, patients with cognitive dysfunction were older at onset (71.52 ± 8.76 VS 63.01 ± 11.73), had longer surgery time (56.9 ± 18.31 VS 43.8 ± 11.9), and had higher preoperative SAS score (60.3 ± + 7.53 VS) 45.91 ± 6.54), longer anesthesia time (71.9 ± 22.1 VS 52.1 ± 13.38), previous surgical treatment history of TN, longer postoperative hospital stay (6.24 ± + 1.76 VS 3.30 ± 1.23), the postoperative pain scores of the two groups were significantly lower than those before operation and were more prone to postoperative irritability.There were no statistical differences in gender, surgical grade, hypertension, coronary heart disease, cerebral infarction, preoperative VAS score, postoperative shivering, postoperative vomiting, and postoperative convulsions, as shown in Table 1.
Variables
|
postoperative cognitive function normal group(N = 73)
|
postoperative cognitive dysfunction group(N = 21)
|
p
|
Table 1
Age
|
63.01 ± 11.73
|
71.52 ± 8.76
|
0.0055*
|
Sex
|
Male
|
32
|
7
|
0.389
|
Female
|
41
|
14
|
|
Surgery time
|
43.8 ± 11.9
|
56.9 ± 18.31
|
0.003*
|
ASA grade
|
|
|
|
I、II
|
62(84.9%)
|
15 (71.4%)
|
0.7689
|
III、IV
|
11(15.1%)
|
6(28.6%)
|
|
hypertension
|
48(65.8%)
|
13(61.9%)
|
0.7477
|
Coronary atherosclerotic disease
|
37(50.7%)
|
9(42.9%)
|
0.5271
|
Cerebral infarction
|
26(35.6%)
|
6(28.6%)
|
0.5481
|
Depression
|
5(6.8%)
|
4(19.0%)
|
0.04*
|
SAS Scores
|
45.91 ± 6.54
|
60.3 ± + 7.53
|
0.001*
|
VAS Scores
|
8.42 ± 0.38
|
8.37 ± 0.42
|
0.7509
|
Duration of anesthesia
|
52.1 ± 13.38
|
71.9 ± 22.1
|
< 0.001*
|
Postoperative vomiting
|
13(17.8%)
|
3(14.3%)
|
0.264
|
Postoperative irritability
|
11(15.1%)
|
8(38.1%)
|
0.0035
|
Postoperative shivering
|
16(21.9%)
|
6(28.6%)
|
0.2332
|
Postoperative convulsions
|
5(6.8%)
|
2(9.5%)
|
0.475
|
Length of postoperative hospital stay
|
3.30 ± 1.23
|
6.24 ± + 1.76
|
< 0.001*
|
Previous surgical history
|
3(4.1%)
|
4(19.0%)
|
0.02*
|
Preoperative MMSE
|
28.4 ± 1.23
|
28.1 ± 1.28
|
0.7853
|
Postoperative VAS
|
3.42 ± 0.54
|
3.45 ± 0.76
|
0.7432
|
ASA, ASA grade ; SAS, self rating anxiety scale; VAS, visual analog scale |
Result 3: Functional Mri Findings Of Patients With Postoperative Cognitive Function
A total of three patients completed the functional MRI examination after the surgery. The patients showed non-specific manifestations, such as multiple lacunar infarctions, partial swelling, and brain tissue softening (see Fig. 2A and Fig. 2B). Scattered patchy abnormal signals were seen in the lateral ventricle, frontoparietal lobe, and white matter deformation in three patients, as shown Fig. 2C and Fig. 2D.
Result 4: Risk factors and independent risk factors for postoperative cognitive impairment;
According to Table 2, univariate and multivariate regression analyses were performed for postoperative cognitive dysfunction as the cause of death in patients with TN. The univariate retrospective analysis found that advanced age, high preoperative SAS score, prolonged anaesthesia time, prolonged length of operation, depression, and previous history of TN surgery were risk factors for postoperative cognitive impairment. Multivariate regression analysis was performed after age reassignment, high preoperative SAS score, long anesthesia time, prolonged operation time, depression, and history of trigeminal nerve surgery. It was found that age, high preoperative SAS score and long anesthesia time were independent risk factors for postoperative cognitive dysfunction in patients with TN, as detailed in Table 3.
Table 2
Risk factor assignment method
Variables
|
Description of assignment
|
|
Age
|
≥ 70 = 1
|
< 70 = 0
|
Gender
|
Female = 1
|
Male = 0
|
ASA score
|
≥ 60 = 1
|
< 60 = 0
|
VAS score
|
≥ 8 = 1
|
< 8 = 0
|
Duration of surgery
|
≥ 50 = 1
|
< 50 = 0
|
Anesthesia time
|
≥ 60 = 1
|
< 60 = 0
|
Depression
|
Appearance = 1
|
Don’t appear = 0
|
Cerebral infarction
|
Appearance = 1
|
Don’t appear = 0
|
ASA Surgical Grade
|
III、IV = 1
|
I、II = 0
|
Recovery time
|
≥ 10 = 1
|
< 10 = 0
|
Previous surgical history
|
Appearance = 1
|
Don’t appear = 0
|
ASA, ASA grade ; SAS, self rating anxiety scale; VAS, visual analog scale |
Result 5: HBO could effectively alleviate postoperative cognitive dysfunction.
The patients with postoperative cognitive dysfunction were divided into the HBO group and the non-HBO group. A total of 8 patients were treated with HBO, and 13 patients were not treated with HBO. The MMSE scores were recorded on the 1st, 3rd, and nd 5th day after surgery.
The study found no significant difference in the MMSE scores on the 1st day after surgery between the two groups compared with the patients without HBO treatment (see Fig. 3.A). The MMSE scores on the 3rd and 5th day after surgery were significantly higher than those in the control group (Fig. 3B and Fig. 3C). Moreover, after HBO treatment, the MMSE scores of the patients in the HBO group increased faster, and there were no patients with persistent cognitive dysfunction, as shown in Fig. 3.
Result 6: Correlation Analysis Of Mmse Scores
In this study, the MMSE score indicates postoperative cognitive dysfunction in patients. The results showed that the depression score SAS was negatively correlated with the MMSE score (R = 0.3541,p < 0.001), while there was no significant linear relationship between anesthesia time, operation time, preoperative pain score, and MMSE score, as shown in Fig. 4.