Microvascular decompression in trigeminal neuralgia - a prospective study of 115 patients

J Headache Pain. 2022 Nov 19;23(1):145. doi: 10.1186/s10194-022-01520-x.

Abstract

Background: Trigeminal neuralgia is a severe facial pain disorder. Microvascular decompression is first choice surgical treatment of patients with classical TN. There exist few prospective studies with an independent evaluation of efficacy and complications after MVD.

Objectives: We aimed to assess outcome and complications after microvascular decompression from our center.

Methods: We prospectively recorded clinical characteristics, outcome, and complications from consecutive patients with either classical or idiopathic (only patients with a neurovascular contact) trigeminal neuralgia undergoing microvascular decompression. Neurovascular contact was evaluated by 3.0 Tesla MRI. Patients were assessed before and 3, 6, 12, and 24 months after surgery by independent assessors.

Results: Of 115 included patients, 86% had a clinically significant outcome (i.e., BNI I - BNI IIIb). There was a significant association between an excellent surgical outcome and the male sex (OR 4.9 (CI 1.9-12.8), p = 0.001) and neurovascular contact with morphological changes (OR 2.5 (CI 1.1-6.0), p = 0.036). Significantly more women (12/62 = 19%) than men (2/53 = 4%) had a failed outcome, p = 0.019. The most frequent major complications were permanent hearing impairment (10%), permanent severe hypoesthesia (7%), permanent ataxia (7%), and stroke (6%). Most patients (94%) recommend surgery to others.

Conclusion: Microvascular decompression is an effective treatment for classical and idiopathic (only patients with a neurovascular contact) trigeminal neuralgia with a high chance of a long-lasting effect. The chance of an excellent outcome was highest in men and in patients with classical trigeminal neuralgia. Complications are relatively frequent warranting thorough patient evaluation and information preoperatively.

Trial registration: Clinical.

Trials: gov registration no. NCT04445766 .

Keywords: Complication; Neurosurgery; Outcome.

Publication types

  • Clinical Study

MeSH terms

  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Microvascular Decompression Surgery*
  • Prospective Studies
  • Treatment Outcome
  • Trigeminal Neuralgia* / diagnostic imaging
  • Trigeminal Neuralgia* / etiology
  • Trigeminal Neuralgia* / surgery

Associated data

  • ClinicalTrials.gov/NCT04445766