Clinical characteristics of postoperative cognitive dysfunction after local balloon compression for trigeminal neuralgia: a retrospective study

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Methods A retrospective study was conducted among 94 TN patients that underwent percutaneous balloon compression in the Affiliated Huai 'an First People's Hospital of Nanjing Medical University from 2017 to 2022. Patients were divided according to the post- Mini-Mental State Examimation (MMSE) scores (postoperative cognitive dysfunction and postoperative cognitive function normal groups). General information, past medical history, laboratory examination, treatment methods, self rating anxiety scale (SAS) score, visual analog scale (VAS) score and MMSE score were collected. Results Total 21 patients developed postoperative cognitive impairment, of which 16 were transient, and 3 were prolonged. Postoperative cognitive impairment prolonged the hospital stay (p< 0.001). Advanced age (p = 0.028), high preoperative SAS score (p < 0.001), and prolonged anesthesia duration (p < 0.032) were independent risk factors for surgical patients of TN. Three patients in the postoperative cognitive dysfunction group showed brain swelling and extensive white matter degeneration in the frontal and parietal lobes. Eight patients were treated with hyperbaric oxygen (HBO), following which, the MMSE score was significantly higher (p < 0.05) than that in the group without HBO, with no long-term complications. Preoperative SAS score was negatively correlated with the postoperative MMSE score (R = 0.3541, p < 0.001). Conclusion Postoperative cognitive dysfunction prolongs hospital stay in patients with TN. Functional magnetic resonance imaging can reflect brain tissue damage, and HBO therapy helps in postoperative cognitive function recovery. trigeminal neuralgia balloon compression postoperative cognitive dysfunction independent risk factors functional magnetic resonance imaging Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Trigeminal neuralgia (TN) is a type of repeated unilateral pain resembling electric shock, knife cut, tear, or shock in the trigeminal nerve distribution area. Pain duration varies from a few seconds to a few minutes [ 1 ] and is divided into primary and secondary TN [ 2 , 3 ]. In an epidemiological survey in Europe and China, TN was observed in about four in 100 000 to 25 in 100 000 individuals, respectively. The age onset is relatively high, and the incidence is higher in women than men, with some patients suffering from lifelong pain [ 4 – 6 ]. Long-term chronic pain from TN causes sleeping difficulties, swallowing, and language disorders, and it also increases the risk of anxiety, depression, and other psychological disorders [ 7 ]. Since TN pathogenesis remains unclear, the affected patient population remains significantly large, with some needing companionship due to chronic pain. Hence, greater awareness is warranted towards this condition. TN treatment can either be surgical or through drug medication, with the latter being most commonly used as a symptomatic treatment. On the other hand, surgery is the primary treatment for chronic TN, including balloon compression, microvascular decompression, and trigeminal nerve root injury [ 8 – 10 ]. Among these surgical procedures, trigeminal nerve percutaneous balloon compression (PBC) is the most widely used since it results in minimal injury, rapid recovery, and stable effects. However, it may also be accompanied by complications such as local numbness, muscle atrophy, diplopia, bleeding at the puncture site, subarachnoid hemorrhage, and brain hematoma [ 11 – 13 ]. Postoperative cognitive dysfunction is a rarely-occurring complication that can affect long-term prognosis. Patients often have memory loss, speech disorders, poor orientation, and sleep disorders after surgery [ 14 , 15 ]. Clinically, postoperative cognitive dysfunction in TN patients is often considered to be transient and can mistakenly be thought that the patient's recovery speed is slow, the pain is not relieved, and the anxiety symptoms are aggravated; this aspect has not received enough attention. Postoperative cognitive dysfunction can affect the long-term survival rate of patients with TN and aggravate their existing psychological disorders, thus, needing close observation. The study aimed to analyze the clinical manifestations and laboratory characteristics of postoperative cognitive dysfunction among TN patients with early onset to identify the high-risk population, reduce the incidence of postoperative cognitive function, and improve the long-term prognosis of TN patients, which can eventually lead to earlier identification, intervention, and treatment of the condition. Methods Study population From January 2017 to December 2022, 99 pTN patients who underwent PBC in the Affiliated Huai 'an First People's Hospital of Nanjing Medical University were enrolled in this study. Inclusion criteria included: 1) adult patients (18–75 years old), 2) Length of hospital stay: morev than 7 days, 3) complete follow-up records for one month after discharge. Exclusion criteria included: 1) Individuals with severe mental illness, 2) with significant cognitive impairment before surgery, 3) pregnant women or cancer patients, 4)There was preoperative cognitive dysfunction, 5༉MMSE score ≤ 26; Data Collection And Grouping The general patient preoperative data were recorded, including age, gender, past medical history (such as diabetes mellitus, coronary heart disease, respiratory disease, depression, and other psychological disorders), self-rating anxiety scale (SAS), visual analog scale (VAS), and ASA surgical classification. The anesthesia depth, anesthesia time, operative time, and dosage of anesthetic drugs were recorded. The postoperative Mini-Mental State Examimation (MMSE) complications, postoperative recovery time, use of wake-up drugs, postoperative MMSE score, NHISS score, postoperative neurological examination, and postoperative treatment drugs were recorded. The MMSE score at 1 hour after surgery was measured, and MMSE score ≤ 26 was defined as postoperative cognitive dysfunction, the patients with TN were divided into postoperative cognitive dysfunction group (N = 21) and postoperative cognitive function normal group (N = 73). Surgical Anesthetic Procedure Before anesthesia, the patient fasted for 12 hours, and water was withheld for 6 hours without preoperative medication. After admission to the hospital, the patient's vital signs were monitored, and the intravenous channel was opened for preoperative induction: hydroprednisone 20 mg, midazolam 2 mg, etomidate 20 mg, sufentanil 0.5 ug/kg, rocuronium 40 mg were administered. After induction, radial artery puncture and internal jugular vein catheterization were performed. After anesthesia was completed, the anesthesia depth was maintained with propofol 5–7 mg/kg/h, remifentanil 4 mg/kg/h, cisatracurium 6 mg/h, sevoflurane 1%, and dexmedetomidine 0.5 ug/kg/h. The patient's vital signs were then closely monitored during PBC surgery under the guidance of a CT. PBC procedure:The patient was placed in the supine position with the head fixed after tracheal intubation. Under the guidance of CT, the patient's skull was scanned and three-dimensional reconstruction was performed to determine the site of foramen ovale puncture. After the Angle was determined, the 14-gauge needle was inserted 2.5cm from the Angle of the mouth of the affected side. Under the guidance of X-ray, the needle was inserted slowly. Then the guide wire was pulled out 1cm away from the tip of the needle, and the contrast agent was used. When the shape of the balloon was "pear-shaped" first indicated by X, the balloon catheter and the puncture needle catheter were removed after compression for 240 seconds Statistical analysis The IBM SPSS statistics version 21.0 (IBM Inc., Armonk, New York, USA) was used for data analysis. The numbers conforming to normal distribution were expressed as mean ± standard deviation, and the numbers between the two groups were analyzed by one-way analysis of variance (One-way ANOVA). Count data were expressed as n (%), and the chi-square test analyzed the group comparison. The risk factors were analyzed through a one-way analysis of variance, and the independent risk factors were analyzed using multivariate analysis of variance. Continuous dynamic variables were analyzed by continuous dynamic analysis (GEE), and p ≤ 0.05 was considered statistically significant. Results 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 Baseline of patients 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. 2 A and Fig. 2 B). Scattered patchy abnormal signals were seen in the lateral ventricle, frontoparietal lobe, and white matter deformation in three patients, as shown Fig. 2 C and Fig. 2 D. 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. 3 B and Fig. 3 C). 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 . Discussion Trigeminal neuralgia is a condition associated with recurring pain in the trigeminal nerve area with unknown pathogenesis, for which drug therapy and surgicies are the main stays of treatment. Local balloon compression of the trigeminal nerve is the primary surgical method, and postoperative cognitive dysfunction is a rare and serious complication affecting the long-term patient prognosis. In order to reduce the incidence of postoperative cognitive dysfunction, early identification of high-risk patients is important. Postoperative cognitive dysfunction can manifest as postoperative anxiety, speech disorder, poor orientation, and can affect patients' quality of life. Several studies have confirmed that the risk factors for postoperative cognitive dysfunction include advanced age, long operation time, surgical anesthesia, etc. [ 16 – 18 ]. However, there are few reports of postoperative cognitive deficits in patients with TN [ 19 , 20 ]. In this study, through univariate and multivariate regression analysis, it was found that advanced age, higher preoperative SAS score, and longer anesthesia time were independent risk factors for postoperative cognitive dysfunction in patients with TN. The cause of cognitive dysfunction after trigeminal nerve PBC may be related to neuroinflammatory factor storm. When the local stress response of brain tissue caused by anesthesia and surgery increases, a large number of inflammatory factors are produced, resulting in severe inflammatory factor storms that destroy the local microcirculation of tissues in the body and penetration of the blood-brain barrier; thus, causing local inflammatory changes in brain tissue. It can damage nerve cells and increase cell membrane permeability, leading to brain edema and postoperative cognitive dysfunction [ 21 , 22 ]. Several previous studies have suggested that mitochondrial ATP-sensitive potassium channels play an important role in this process [ 23 – 25 ]. Brain edema and nerve tissue degeneration may indicate cognitive impairment. Hence, functional MRI helps evaluate brain tissue's structural and functional changes. In this study, 3 patients underwent functional MRI examination after surgery. The patients showed varying degrees of swelling, softening, and white matter degeneration in the frontal and parietal regions, consistent with the theoretical basis of brain tissue edema in the past. Therefore, in patients with postoperative cognitive dysfunction, functional MRI may help in disease diagnosis and determine the disease severity. The SAS score can reflect the degree of anxiety and depression of patients. Our study suggests that the SAS score of patients with postoperative cognitive dysfunction is significantly higher than that of patients without postoperative cognitive dysfunction. A high SAS score is a risk factor for postoperative cognitive function. In a previous prospective study, researchers adminstered patients with oral anti-anxiety drugs before they underwent abdominal surgery, which could effectively reduce the incidence of postoperative cognitive function [ 26 ]. Preoperative anti-anxiety therapy may be an effective means to prevent postoperative cognitive function [ 27 , 28 ], and in correlation analysis, the preoperative SAS score is positively correlated with the MMSE score. Therefore, the preoperative SAS score can reflect the postoperative cognitive dysfunction index, and preoperative active anti-anxiety treatment may effectively prevent postoperative cognitive dysfunction. HBO is a treatment in which 100% oxygen concentration is inhaled in more than one atmosphere. HBO can rapidly increase the blood oxygen content in the body and accelerate oxygen diffusion, quickly improving body tissue hypoxia. It also inhibits oxygen free radicals, reduces the permeability of blood vessels, reduces the permeability of blood vessels local edema, and reduces blood viscosity and other functions. It has an excellent therapeutic effect on ischemic brain disease, severe craniocerebral injury, coronary heart disease, spinal cord injury, carbon monoxide poisoning, and other diseases [ 29 – 34 ]. This study treated 8 patients with postoperative cognitive dysfunction with HBO and revealed that compared with the patients without HBO treatment, the MMSE score of these patients increased rapidly and significantly, and cognitive dysfunction symptoms improved more significantly after HBO treatment, with no obvious postoperative cognitive dysfunction. Therefore, HBO therapy may be an effective means of treating postoperative cognitive impairment. Limitations This study has several limitations. First, it is a single-center, retrospective study, and only 94 patients were included; Second, only 3 patients underwent functional MRI after surgery, which could not fully reflect the changes in brain tissue after surgery; Third, there are some patients with missing data. Postoperative cognitive impairment is primarily transient and recovery is within 3–5 days after surgery; however, few patients have persistent dysfunction. Long anesthesia time and high preoperative anxiety SAS score are the risk factors for cognitive dysfunction occurence. Moreover, SAS score can reflect disease severity. The preoperative anti-anxiety treatment may lower the incidence of postoperative cognitive dysfunction, and postoperative functional MRI can help in the confirmatory diagnosis and judgement of the condition. HBO can help to accelerate the recovery of postoperative cognitive dysfunction without complications. Declarations Authors' contributions All work was approved by the co-authors. LL and HX made significant contributions to conception and study design. LL、LYG and LM completed data acquisition. LL、LYG and LM performed data analysis and interpretation; LL、LYG and HX have written the draft of the article and critically revised it. No conflicts of interest exist in the submission of this manuscript. I would like to declare on behalf of my co-authors that the work described was original research that has not been published previously and is not under consideration for publication elsewhere, in whole or in part. All authors read and approved the final manuscript. Funding NO funding Support the research Ethics approval and consent to participate All experiments in this study were carried out in accordance with the Declaration of Helsinki. This study was approved by the Ethical Committee of The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University. The data used in this study was anonymised before its use and were collected during routine procedures, which did not pose any additional risk to the patients. The requirement for informed consent by individual patients was waived by the Ethical Committee of The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University given the retrospective nature of the study. Availability of Data and Materials The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request. Consent for publication Not applicable. Competing interest The authors declare that they have no confict of interest. Acknowledgement Not applicable' for the section. Author details 1 ： Department of Anesthesia Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, No.1, Huanghe West Road, Huaiyin District, Huai'an, 223300, Jiangsu, China.; 2 ： Department of Cardiothoracic Surgery，The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, No.1, Huanghe West Road, Huaiyin District, Huai'an, 223300, Jiangsu, China.; 3：Department of Laboratory medicine department，The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, No.1, Huanghe West Road, Huaiyin District, Huai'an, 223300, Jiangsu, China.; References Tohyama S, Walker MR, Zhang JY, Cheng JC, Hodaie M. Brainstem trigeminal fiber microstructural abnormalities are associated with treatment response across subtypes of trigeminal neuralgia. Pain. 2021;162:1790–9, PMID: 33306503, PMCID: PMC8120686. Cruccu G, Di Stefano G, Truini A. Trigeminal neuralgia. N Engl J Med. 2020;383:754–62. 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PMID: 31051059. Smuder AJ, Turner SM, Schuster CM, Morton AB, Hinkley JM, Fuller DD. Hyperbaric oxygen treatment following mid-cervical spinal cord injury preserves diaphragm muscle function. Int J Mol Sci. 2020;21:7219, PMID: 33007822, PMCID: PMC7582297. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2649508","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":183695623,"identity":"b9804f57-a2cd-486a-9521-3e35cb6b885e","order_by":0,"name":"LI lin","email":"","orcid":"","institution":"The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"LI","middleName":"","lastName":"lin","suffix":""},{"id":183695625,"identity":"5046abd8-5c45-4a73-8bf9-7f356b62aaa7","order_by":1,"name":"Luo yonggang","email":"","orcid":"","institution":"The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Luo","middleName":"","lastName":"yonggang","suffix":""},{"id":183695627,"identity":"c493907a-7a18-4b2c-99bc-b77349a68261","order_by":2,"name":"Liu min","email":"","orcid":"","institution":"The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Liu","middleName":"","lastName":"min","suffix":""},{"id":183695629,"identity":"2ab62064-9fa1-473f-940c-da2154ff3c94","order_by":3,"name":"He xue","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYBACNvbmA4d/GEjwyLM3H3yQUFFDWAsfz7HEwwwFFnKGPceSDR6cOUZYi5xEjvFhhg8Vxgw3fMwkH7YwE+EwnjMGhwsMJBIbZ7ClVSQ2sDHwt3cnEPBLW8HhGUAt7dLNx24k7pBhkDhzdgMBWw5vOMADsmXOsbQbiWfYGAwkcglokUgwAGtpuJFjVpDYxkyMlhSDw0AtQO/nmDEQp4XnWMJBoF/AgSyRcOYYD0G/yLc3H/7w4U8dOCo//qiokeNv78WvBQPwkKZ8FIyCUTAKRgFWAAB3HU9Lcunq+wAAAABJRU5ErkJggg==","orcid":"","institution":"The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"He","middleName":"","lastName":"xue","suffix":""}],"badges":[],"createdAt":"2023-03-03 02:59:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2649508/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2649508/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":34599507,"identity":"df427ba8-f304-4387-b6d5-a5f7287d891a","added_by":"auto","created_at":"2023-03-21 16:21:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111555,"visible":true,"origin":"","legend":"\u003cp\u003eEnrolment flow chart for trigeminal neuralgia patients.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-2649508/v1/92a0813a59aeb2d1103e9a26.png"},{"id":34599508,"identity":"321da44c-6896-476b-b2b6-da180bf3bad2","added_by":"auto","created_at":"2023-03-21 16:21:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":493235,"visible":true,"origin":"","legend":"\u003cp\u003ePanels A and B show lacunar infarction with softening lesions in brain tissue. Panels C and D show brain parenchymal degeneration.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-2649508/v1/679c0f7e52d73ef217f179b1.png"},{"id":34599506,"identity":"186b0de8-ea03-44e6-b43d-babdb854910e","added_by":"auto","created_at":"2023-03-21 16:21:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29066,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDynamic changes of MMSE scores in patients after HBO therapy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePanel A shows the MMSE score on the first postoperative day, panel B shows the MMSE score on the third postoperative day, and panel C shows the MMSE score on the fifth postoperative day\u003c/p\u003e\n\u003cp\u003eMMSE, Mini-Mental State Examimation; HBO, Hyperbaric oxygen\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-2649508/v1/3e8da5bd5aed0c9d4229bbbf.png"},{"id":34599509,"identity":"6eaa52a3-a689-46f5-8cc0-d387d6cc72a5","added_by":"auto","created_at":"2023-03-21 16:21:17","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":55481,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCorrelation analysis of MMSE scores\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePanel A shows the correlation analysis between the SAS and MMSE scores; Panel B shows the correlation between anesthesia time and MMSE scores. Panel C shows the correlation analysis between operative time and MMSE score. Panel D shows the correlation analysis between the VAS score and the MMSE score.\u003c/p\u003e\n\u003cp\u003eSAS, self rating anxiety scale; MMSE, Mini-Mental State Examimation\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-2649508/v1/8ec3e87809bc56dd8cb59274.png"},{"id":35125469,"identity":"2243d695-749f-4d62-a739-3289f004bf34","added_by":"auto","created_at":"2023-03-31 21:44:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1286706,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2649508/v1/4b43c0b9-005c-45ad-8d08-2d6b1a69b7ab.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical characteristics of postoperative cognitive dysfunction after local balloon compression for trigeminal neuralgia: a retrospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTrigeminal neuralgia (TN) is a type of repeated unilateral pain resembling electric shock, knife cut, tear, or shock in the trigeminal nerve distribution area. Pain duration varies from a few seconds to a few minutes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and is divided into primary and secondary TN [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In an epidemiological survey in Europe and China, TN was observed in about four in 100 000 to 25 in 100 000 individuals, respectively. The age onset is relatively high, and the incidence is higher in women than men, with some patients suffering from lifelong pain [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Long-term chronic pain from TN causes sleeping difficulties, swallowing, and language disorders, and it also increases the risk of anxiety, depression, and other psychological disorders [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Since TN pathogenesis remains unclear, the affected patient population remains significantly large, with some needing companionship due to chronic pain. Hence, greater awareness is warranted towards this condition.\u003c/p\u003e \u003cp\u003eTN treatment can either be surgical or through drug medication, with the latter being most commonly used as a symptomatic treatment. On the other hand, surgery is the primary treatment for chronic TN, including balloon compression, microvascular decompression, and trigeminal nerve root injury [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Among these surgical procedures, trigeminal nerve percutaneous balloon compression (PBC) is the most widely used since it results in minimal injury, rapid recovery, and stable effects. However, it may also be accompanied by complications such as local numbness, muscle atrophy, diplopia, bleeding at the puncture site, subarachnoid hemorrhage, and brain hematoma [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Postoperative cognitive dysfunction is a rarely-occurring complication that can affect long-term prognosis. Patients often have memory loss, speech disorders, poor orientation, and sleep disorders after surgery [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Clinically, postoperative cognitive dysfunction in TN patients is often considered to be transient and can mistakenly be thought that the patient's recovery speed is slow, the pain is not relieved, and the anxiety symptoms are aggravated; this aspect has not received enough attention. Postoperative cognitive dysfunction can affect the long-term survival rate of patients with TN and aggravate their existing psychological disorders, thus, needing close observation.\u003c/p\u003e \u003cp\u003eThe study aimed to analyze the clinical manifestations and laboratory characteristics of postoperative cognitive dysfunction among TN patients with early onset to identify the high-risk population, reduce the incidence of postoperative cognitive function, and improve the long-term prognosis of TN patients, which can eventually lead to earlier identification, intervention, and treatment of the condition.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eFrom January 2017 to December 2022, 99 pTN patients who underwent PBC in the Affiliated Huai 'an First People's Hospital of Nanjing Medical University were enrolled in this study. Inclusion criteria included: 1) adult patients (18\u0026ndash;75 years old), 2) Length of hospital stay: morev than 7 days, 3) complete follow-up records for one month after discharge. Exclusion criteria included: 1) Individuals with severe mental illness, 2) with significant cognitive impairment before surgery, 3) pregnant women or cancer patients, 4)There was preoperative cognitive dysfunction, 5༉MMSE score\u0026thinsp;\u0026le;\u0026thinsp;26;\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection And Grouping\u003c/h3\u003e\n\u003cp\u003eThe general patient preoperative data were recorded, including age, gender, past medical history (such as diabetes mellitus, coronary heart disease, respiratory disease, depression, and other psychological disorders), self-rating anxiety scale (SAS), visual analog scale (VAS), and ASA surgical classification. The anesthesia depth, anesthesia time, operative time, and dosage of anesthetic drugs were recorded. The postoperative Mini-Mental State Examimation (MMSE) complications, postoperative recovery time, use of wake-up drugs, postoperative MMSE score, NHISS score, postoperative neurological examination, and postoperative treatment drugs were recorded.\u003c/p\u003e \u003cp\u003eThe MMSE score at 1 hour after surgery was measured, and MMSE score\u0026thinsp;\u0026le;\u0026thinsp;26 was defined as postoperative cognitive dysfunction, the patients with TN were divided into postoperative cognitive dysfunction group (N\u0026thinsp;=\u0026thinsp;21) and postoperative cognitive function normal group (N\u0026thinsp;=\u0026thinsp;73).\u003c/p\u003e\n\u003ch3\u003eSurgical Anesthetic Procedure\u003c/h3\u003e\n\u003cp\u003eBefore anesthesia, the patient fasted for 12 hours, and water was withheld for 6 hours without preoperative medication. After admission to the hospital, the patient's vital signs were monitored, and the intravenous channel was opened for preoperative induction: hydroprednisone 20 mg, midazolam 2 mg, etomidate 20 mg, sufentanil 0.5 ug/kg, rocuronium 40 mg were administered. After induction, radial artery puncture and internal jugular vein catheterization were performed. After anesthesia was completed, the anesthesia depth was maintained with propofol 5\u0026ndash;7 mg/kg/h, remifentanil 4 mg/kg/h, cisatracurium 6 mg/h, sevoflurane 1%, and dexmedetomidine 0.5 ug/kg/h. The patient's vital signs were then closely monitored during PBC surgery under the guidance of a CT.\u003c/p\u003e \u003cp\u003ePBC procedure:The patient was placed in the supine position with the head fixed after tracheal intubation. Under the guidance of CT, the patient's skull was scanned and three-dimensional reconstruction was performed to determine the site of foramen ovale puncture. After the Angle was determined, the 14-gauge needle was inserted 2.5cm from the Angle of the mouth of the affected side. Under the guidance of X-ray, the needle was inserted slowly. Then the guide wire was pulled out 1cm away from the tip of the needle, and the contrast agent was used. When the shape of the balloon was \"pear-shaped\" first indicated by X, the balloon catheter and the puncture needle catheter were removed after compression for 240 seconds\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe IBM SPSS statistics version 21.0 (IBM Inc., Armonk, New York, USA) was used for data analysis. The numbers conforming to normal distribution were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and the numbers between the two groups were analyzed by one-way analysis of variance (One-way ANOVA). Count data were expressed as n (%), and the chi-square test analyzed the group comparison. The risk factors were analyzed through a one-way analysis of variance, and the independent risk factors were analyzed using multivariate analysis of variance. Continuous dynamic variables were analyzed by continuous dynamic analysis (GEE), and p\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec8\"\u003e\n \u003ch2\u003eResult 1: Number of patients and exclusion criteria\u003c/h2\u003e\n \u003cp\u003eA total of 133 TN patients treated by surgery were admitted to the Affiliated Huai \u0026apos;an First People\u0026apos;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.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Moreover, eight patients were treated with HBO after surgery.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eResult 2: Baseline Characteristics Of The Patients\u003c/h3\u003e\n\u003cp\u003eThe 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\u0026thinsp;\u0026plusmn;\u0026thinsp;8.76 VS 63.01\u0026thinsp;\u0026plusmn;\u0026thinsp;11.73), had longer surgery time (56.9\u0026thinsp;\u0026plusmn;\u0026thinsp;18.31 VS 43.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9), and had higher preoperative SAS score (60.3\u0026thinsp;\u0026plusmn;\u0026thinsp;+\u0026thinsp;7.53 VS) 45.91\u0026thinsp;\u0026plusmn;\u0026thinsp;6.54), longer anesthesia time (71.9\u0026thinsp;\u0026plusmn;\u0026thinsp;22.1 VS 52.1\u0026thinsp;\u0026plusmn;\u0026thinsp;13.38), previous surgical treatment history of TN, longer postoperative hospital stay (6.24\u0026thinsp;\u0026plusmn;\u0026thinsp;+\u0026thinsp;1.76 VS 3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;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 \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003epostoperative cognitive function normal group(N\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003epostoperative cognitive dysfunction group(N\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline of patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.01\u0026thinsp;\u0026plusmn;\u0026thinsp;11.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.52\u0026thinsp;\u0026plusmn;\u0026thinsp;8.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0055*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgery time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.9\u0026thinsp;\u0026plusmn;\u0026thinsp;18.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI、II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62(84.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7689\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIII、IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(15.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48(65.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(61.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7477\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoronary atherosclerotic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37(50.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5271\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCerebral infarction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(35.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5481\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(19.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSAS Scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.91\u0026thinsp;\u0026plusmn;\u0026thinsp;6.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.3\u0026thinsp;\u0026plusmn;\u0026thinsp;+\u0026thinsp;7.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS Scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7509\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.1\u0026thinsp;\u0026plusmn;\u0026thinsp;13.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.9\u0026thinsp;\u0026plusmn;\u0026thinsp;22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.264\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative irritability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(15.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(38.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative shivering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2332\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative convulsions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength of postoperative hospital stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.24\u0026thinsp;\u0026plusmn;\u0026thinsp;+\u0026thinsp;1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrevious surgical history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(19.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative MMSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7853\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative VAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7432\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eASA, ASA grade ; SAS, self rating anxiety scale; VAS, visual analog scale\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eResult 3: Functional Mri Findings Of Patients With Postoperative Cognitive Function\u003c/p\u003e\n\u003cp\u003eA 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. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eA and Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eB). Scattered patchy abnormal signals were seen in the lateral ventricle, frontoparietal lobe, and white matter deformation in three patients, as shown Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eC and Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult 4: Risk factors and independent risk factors for postoperative cognitive impairment;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, 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 \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRisk factor assignment method\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDescription of assignment\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;70\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;70\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;60\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;60\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;8\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;8\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;50\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;50\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnesthesia time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;60\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;60\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAppearance\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDon\u0026rsquo;t appear\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCerebral infarction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAppearance\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDon\u0026rsquo;t appear\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA Surgical Grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIII、IV\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI、II\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecovery time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;10\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;10\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrevious surgical history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAppearance\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDon\u0026rsquo;t appear\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003eASA, ASA grade ; SAS, self rating anxiety scale; VAS, visual analog scale\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1679372155.png\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult 5: HBO could effectively alleviate postoperative cognitive dysfunction.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 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.\u003c/p\u003e\n\u003cp\u003eThe 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.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.A). The MMSE scores on the 3rd and 5th day after surgery were significantly higher than those in the control group (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eB and Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eC). 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.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003eResult 6: Correlation Analysis Of Mmse Scores\u003c/h3\u003e\n\u003cp\u003eIn 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\u0026thinsp;=\u0026thinsp;0.3541,p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while there was no significant linear relationship between anesthesia time, operation time, preoperative pain score, and MMSE score, as shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTrigeminal neuralgia is a condition associated with recurring pain in the trigeminal nerve area with unknown pathogenesis, for which drug therapy and surgicies are the main stays of treatment. Local balloon compression of the trigeminal nerve is the primary surgical method, and postoperative cognitive dysfunction is a rare and serious complication affecting the long-term patient prognosis. In order to reduce the incidence of postoperative cognitive dysfunction, early identification of high-risk patients is important.\u003c/p\u003e \u003cp\u003ePostoperative cognitive dysfunction can manifest as postoperative anxiety, speech disorder, poor orientation, and can affect patients' quality of life. Several studies have confirmed that the risk factors for postoperative cognitive dysfunction include advanced age, long operation time, surgical anesthesia, etc. [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, there are few reports of postoperative cognitive deficits in patients with TN [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In this study, through univariate and multivariate regression analysis, it was found that advanced age, higher preoperative SAS score, and longer anesthesia time were independent risk factors for postoperative cognitive dysfunction in patients with TN.\u003c/p\u003e \u003cp\u003eThe cause of cognitive dysfunction after trigeminal nerve PBC may be related to neuroinflammatory factor storm. When the local stress response of brain tissue caused by anesthesia and surgery increases, a large number of inflammatory factors are produced, resulting in severe inflammatory factor storms that destroy the local microcirculation of tissues in the body and penetration of the blood-brain barrier; thus, causing local inflammatory changes in brain tissue. It can damage nerve cells and increase cell membrane permeability, leading to brain edema and postoperative cognitive dysfunction [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Several previous studies have suggested that mitochondrial ATP-sensitive potassium channels play an important role in this process [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Brain edema and nerve tissue degeneration may indicate cognitive impairment. Hence, functional MRI helps evaluate brain tissue's structural and functional changes. In this study, 3 patients underwent functional MRI examination after surgery. The patients showed varying degrees of swelling, softening, and white matter degeneration in the frontal and parietal regions, consistent with the theoretical basis of brain tissue edema in the past. Therefore, in patients with postoperative cognitive dysfunction, functional MRI may help in disease diagnosis and determine the disease severity.\u003c/p\u003e \u003cp\u003eThe SAS score can reflect the degree of anxiety and depression of patients. Our study suggests that the SAS score of patients with postoperative cognitive dysfunction is significantly higher than that of patients without postoperative cognitive dysfunction. A high SAS score is a risk factor for postoperative cognitive function. In a previous prospective study, researchers adminstered patients with oral anti-anxiety drugs before they underwent abdominal surgery, which could effectively reduce the incidence of postoperative cognitive function [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Preoperative anti-anxiety therapy may be an effective means to prevent postoperative cognitive function [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], and in correlation analysis, the preoperative SAS score is positively correlated with the MMSE score. Therefore, the preoperative SAS score can reflect the postoperative cognitive dysfunction index, and preoperative active anti-anxiety treatment may effectively prevent postoperative cognitive dysfunction.\u003c/p\u003e \u003cp\u003eHBO is a treatment in which 100% oxygen concentration is inhaled in more than one atmosphere. HBO can rapidly increase the blood oxygen content in the body and accelerate oxygen diffusion, quickly improving body tissue hypoxia. It also inhibits oxygen free radicals, reduces the permeability of blood vessels, reduces the permeability of blood vessels local edema, and reduces blood viscosity and other functions. It has an excellent therapeutic effect on ischemic brain disease, severe craniocerebral injury, coronary heart disease, spinal cord injury, carbon monoxide poisoning, and other diseases [\u003cspan additionalcitationids=\"CR30 CR31 CR32 CR33\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This study treated 8 patients with postoperative cognitive dysfunction with HBO and revealed that compared with the patients without HBO treatment, the MMSE score of these patients increased rapidly and significantly, and cognitive dysfunction symptoms improved more significantly after HBO treatment, with no obvious postoperative cognitive dysfunction. Therefore, HBO therapy may be an effective means of treating postoperative cognitive impairment.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study has several limitations. First, it is a single-center, retrospective study, and only 94 patients were included; Second, only 3 patients underwent functional MRI after surgery, which could not fully reflect the changes in brain tissue after surgery; Third, there are some patients with missing data.\u003c/p\u003e \u003cp\u003ePostoperative cognitive impairment is primarily transient and recovery is within 3\u0026ndash;5 days after surgery; however, few patients have persistent dysfunction. Long anesthesia time and high preoperative anxiety SAS score are the risk factors for cognitive dysfunction occurence. Moreover, SAS score can reflect disease severity. The preoperative anti-anxiety treatment may lower the incidence of postoperative cognitive dysfunction, and postoperative functional MRI can help in the confirmatory diagnosis and judgement of the condition. HBO can help to accelerate the recovery of postoperative cognitive dysfunction without complications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll work was approved by the co-authors. LL and HX made significant contributions to conception and study design. LL、LYG and LM completed data acquisition. \u0026nbsp;LL、LYG and LM \u0026nbsp; performed data analysis and interpretation; \u0026nbsp;LL、LYG and HX have written the draft of the article and critically revised it. No conflicts of interest exist in the submission of this manuscript. I would like to declare on behalf of my co-authors that the work described was original research that has not been published previously and is not under consideration for publication elsewhere, in whole or in part. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNO funding Support the research\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll experiments in this study were carried out in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethical Committee of The Affiliated Huaian No.1 People\u0026apos;s Hospital of Nanjing Medical University. The data used in this study was anonymised before its use and were collected during routine procedures, which did not pose any additional risk to the patients. The requirement for informed consent by individual patients was waived by the Ethical Committee of The Affiliated Huaian No.1 People\u0026apos;s Hospital of Nanjing Medical University given the retrospective nature of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no confict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026apos; for the section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eDepartment of Anesthesia Surgery, The Affiliated Huaian No.1 People\u0026apos;s Hospital of Nanjing Medical University, No.1, Huanghe West Road, Huaiyin District, Huai\u0026apos;an, 223300, Jiangsu, China.;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eDepartment of\u0026nbsp;Cardiothoracic Surgery，The Affiliated Huaian No.1 People\u0026apos;s Hospital of Nanjing Medical University, No.1, Huanghe West Road, Huaiyin District, Huai\u0026apos;an, 223300, Jiangsu, China.;\u003c/p\u003e\n\u003cp\u003e3：Department of Laboratory medicine department，The Affiliated Huaian No.1 People\u0026apos;s Hospital of Nanjing Medical University, No.1, Huanghe West Road, Huaiyin District, Huai\u0026apos;an, 223300, Jiangsu, China.;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTohyama S, Walker MR, Zhang JY, Cheng JC, Hodaie M. 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Med Gas Res. 2016;6:232\u0026ndash;6, PMID: 28217297, PMCID: PMC5223316.\u003c/li\u003e\n\u003cli\u003eRibeiro AF, Vieira JG, Moniz M, Escobar C, Abadesso C, Amaro C, Cavalheiro D, Guerreiro F, Luis C, Nunez P. Hyperbaric oxygen therapy for hypoxic-ischemic encephalopathy in non-fatal drowning. Undersea Hyperb Med. 2021 First Quarter;48:53\u0026ndash;6, PMID: 33648033.\u003c/li\u003e\n\u003cli\u003eHarch PG, Andrews SR, Rowe CJ, Lischka JR, Townsend MH, Yu Q, Mercante DE. Hyperbaric oxygen therapy for mild traumatic brain injury persistent postconcussion syndrome: A randomized controlled trial. Med Gas Res. 2020;10:8\u0026ndash;20, PMID: 32189664, PMCID: PMC7871939.\u003c/li\u003e\n\u003cli\u003eGonzales-Portillo B, Lippert T, Nguyen H, Lee JY, Borlongan CV. Hyperbaric oxygen therapy: A new look on treating stroke and traumatic brain injury. Brain Circ. 2019;5:101\u0026ndash;5, PMID: 31620655, PMCID: PMC6785945.\u003c/li\u003e\n\u003cli\u003eLi Y, Hao YF, Wang T, Zhang JF, Liang Y, Xiao WL, Guo X. Hyperbaric oxygen may improve vascular endothelial function in patients undergoing coronary stent implantation. Undersea Hyperb Med. 2019;46:145\u0026ndash;52. PMID: 31051059.\u003c/li\u003e\n\u003cli\u003eSmuder AJ, Turner SM, Schuster CM, Morton AB, Hinkley JM, Fuller DD. Hyperbaric oxygen treatment following mid-cervical spinal cord injury preserves diaphragm muscle function. Int J Mol Sci. 2020;21:7219, PMID: 33007822, PMCID: PMC7582297.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"trigeminal neuralgia, balloon compression, postoperative cognitive dysfunction, independent risk factors, functional magnetic resonance imaging","lastPublishedDoi":"10.21203/rs.3.rs-2649508/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2649508/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo identify the high-risk population of trigeminal neuralgia (TN) with postoperative cognitive dysfunction, reduce the consequent long-term postoperative complications, and improve the postoperative quality of life.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective study was conducted among 94 TN patients that underwent percutaneous balloon compression in the Affiliated Huai 'an First People's Hospital of Nanjing Medical University from 2017 to 2022. Patients were divided according to the post- Mini-Mental State Examimation (MMSE) scores (postoperative cognitive dysfunction and postoperative cognitive function normal groups). General information, past medical history, laboratory examination, treatment methods, self rating anxiety scale (SAS) score, visual analog scale (VAS) score and MMSE score were collected.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTotal 21 patients developed postoperative cognitive impairment, of which 16 were transient, and 3 were prolonged. Postoperative cognitive impairment prolonged the hospital stay (p\u0026amp;lt; 0.001). Advanced age (p\u0026thinsp;=\u0026thinsp;0.028), high preoperative SAS score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and prolonged anesthesia duration (p\u0026thinsp;\u0026lt;\u0026thinsp;0.032) were independent risk factors for surgical patients of TN. Three patients in the postoperative cognitive dysfunction group showed brain swelling and extensive white matter degeneration in the frontal and parietal lobes. Eight patients were treated with hyperbaric oxygen (HBO), following which, the MMSE score was significantly higher (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) than that in the group without HBO, with no long-term complications. Preoperative SAS score was negatively correlated with the postoperative MMSE score (R\u0026thinsp;=\u0026thinsp;0.3541, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePostoperative cognitive dysfunction prolongs hospital stay in patients with TN. Functional magnetic resonance imaging can reflect brain tissue damage, and HBO therapy helps in postoperative cognitive function recovery.\u003c/p\u003e","manuscriptTitle":"Clinical characteristics of postoperative cognitive dysfunction after local balloon compression for trigeminal neuralgia: a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-21 16:21:12","doi":"10.21203/rs.3.rs-2649508/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"601273e2-5567-4420-9ea3-9b84bf15235b","owner":[],"postedDate":"March 21st, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-03-31T21:44:15+00:00","versionOfRecord":[],"versionCreatedAt":"2023-03-21 16:21:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2649508","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2649508","identity":"rs-2649508","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}