Microvascular decompression for trigeminal neuralgia outcome

Microvascular decompression for trigeminal neuralgia outcome

Microvascular decompression (MVD) is the most effective long-term surgical treatment for trigeminal neuralgia (TN) patients. The risk factors for poor pain control following MVD surgery are not fully understood.


A significant proportion of patients with significant neurovascular compression fail to achieve long-term pain relief after technically successful surgery. Neuroimaging using magnetic resonance imaging (MRI) provides a non-invasive method to generate objective biomarkers of eventual response to TN surgery 1).


Younger patients with TN had worse long-term pain outcomes following MVD. Additional factors associated with postoperative recurrence included poor preoperative pain control (BNI score > IV) and multivessel compression. Furthermore, SCA combined with PV was confirmed to be associated with a worse outcome 2).


Not all patients with TN manifest unequivocal neurovascular compression (NVC). Furthermore, over time patients with an initially successful MVD manifest a relentless rate of TN recurrence.

It does not achieve 100 % cure rate. Re-exploration of the posterior fossa may carry increased risk over first-time MVD and is not always successful, so other treatments are needed.


Age itself does not seem to represent a major contraindication of microvascular decompression for typical trigeminal neuralgia 3).

Patients 60 yr of age and older have significantly better long-term pain outcomes following MVD than younger patients 4).


1)

Wang Z, Zhao Z, Song Z, Wang Y, Zhao Z. The application of magnetic resonance imaging (MRI) for the prediction of surgical outcomes in trigeminal neuralgia. Postgrad Med. 2022 May 3:1-7. doi: 10.1080/00325481.2022.2067612. Epub ahead of print. PMID: 35503235.
2)

Shi J, Qian Y, Han W, Dong B, Mao Y, Cao J, Guan W, Zhou Q. Risk factors for outcomes following microvascular decompression for trigeminal neuralgia. World Neurosurg. 2020 Jan 17. pii: S1878-8750(20)30100-5. doi: 10.1016/j.wneu.2020.01.082. [Epub ahead of print] PubMed PMID: 31958591.
3)

Mastronardi L, Caputi F, Rinaldi A, Cacciotti G, Roperto R, Scavo CG, Stati G, Sufianov A. Typical Trigeminal Neuralgia: Comparison of Results between Patients Older and Younger than 65 Operated on with Microvascular Decompression by Retrosigmoid Approach. J Neurol Surg A Cent Eur Neurosurg. 2019 Aug 29. doi: 10.1055/s-0039-1693126. [Epub ahead of print] PubMed PMID: 31466107.
4)

Bick SK, Huie D, Sneh G, Eskandar EN. Older Patients Have Better Pain Outcomes Following Microvascular Decompression for Trigeminal Neuralgia. Neurosurgery. 2019 Jan 1;84(1):116-122. doi: 10.1093/neuros/nyy011. PubMed PMID: 29562363.

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