Short and long term follow-up of microvascular decompression for the management of trigeminal neuralgia caused by venous compression

Abstract

Introduction. Classical trigeminal neuralgia is caused by the compression of the trigeminal nerve root and often requires surgical intervention due to the maladaptive intense pain syndrome. Both arteries and veins are considered compressing vessels, however, the role of venous compression in the development of neuralgia remains undefined. The aim of the study was to investigate the effectiveness of microvascular decompression in the treatment of trigeminal neuralgia caused by venous compression, considering the use of various surgical tactics. Material and methods. A retrospective analysis of surgical outcomes in 70 patients who underwent microvascular decompression for trigeminal neuralgia at the Federal Neurosurgical Center (Novosibirsk, Russia) between 2017 and 2021 was conducted. The study included 46 women and 24 men aged 23–82 years with unilateral facial pain. Brain MRI was performed preoperatively to evaluate neuroimaging picture and to clarify the relationships between the trigeminal nerve root and adjacent vessels. The surgical results were assessed during follow-up using the Barrow Neurological Institution (BNI) scale. Results. The study showed that venous neurovascular compression is frequently found in trigeminal neuralgia patients undergoing microvascular decompression in 26.9 % of cases. Various operative strategies were used when venous compression was detected, with high short-term success rates and lower recurrence rates. Long-term monitoring indicated pain relief in 71.4 % of cases (BNI I–II) and pain recurrence in 28.6 % of cases (BNI III, IV, V). Conclusion. This study highlights the effectiveness of microvascular decompression in treating classical trigeminal nerve neuralgia caused by venous compression and emphasizes the importance of individual surgical tactics based on the characteristics of the adjacent veins to achieve optimal results.

Keywords

• trigeminal neuralgia
• microvascular decompression
• venous compression
• neurovascular conflict