Significance of degree of neurovascular compression in surgery for trigeminal neuralgia

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OBJECTIVE

The aim of this study was to identify preoperative imaging predictors of surgical success in patients with classic trigeminal neuralgia (cTN) undergoing microvascular decompression (MVD) via retrospective multivariate regression analysis.

METHODS

All included patients met criteria for cTN and underwent preoperative MRI prior to MVD. MR images were blindly graded regarding the presence and severity (i.e., mild or severe) of neurovascular compression (NVC). All patients were contacted by telephone to determine their postoperative pain status.

RESULTS

A total of 79 patients were included in this study. Sixty-two patients (78.5%) were pain-free without medication following MVD. The following findings were more commonly observed with the symptomatic nerve when compared to the contralateral asymptomatic nerve: NVC (any form), arterial compression alone, NVC along the proximal trigeminal nerve, and severe NVC (p values < 0.0001). The only imaging variable that was a statistically significant predictor of being pain-free without medication following MVD was severe NVC. Patients with severe NVC were 6.36 times more likely to be pain-free following MVD compared to those without severe NVC (p = 0.007).

CONCLUSIONS

In patients with cTN undergoing MVD, severe NVC on preoperative MRI is a strong predictor of an excellent surgical outcome.

ABBREVIATIONS cTN = classic trigeminal neuralgia; IHS = International Headache Society; MVD = microvascular decompression; NVC = neurovascular compression; SSFP = steady-state free precession.
Article Information

Contributor Notes

Correspondence Raymond F. Sekula Jr.: University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA. sekularf@upmc.edu.INCLUDE WHEN CITING Published online June 14, 2019; DOI: 10.3171/2019.3.JNS183174.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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