Short and Long Term Outcomes of Microvascular Decompression forTrigeminal Neuralgia: a single centre experience

Abstract Purpose Microvascular Decompression (MVD) is an effective treatment for Trigeminal Neuralgia (TGN). However anatomical and clinical variables associated with better outcomes are not fully analysed and studies only provide details of immediate complications. This study investigates long-term outcomes of MVD for TGN and how we can predict outcomes for patients. Methods 124 patients with TGN underwent 132 MVD surgeries between February 2012 and November 2021. Patient clinical details, medical management history, magnetic resonance imaging (MRI) findings pre-operatively and intraoperative findings were recorded retrospectively. Results Median age was 63.5 years with a median follow-up of 94 months. 97.5% of operations had immediate improvement in pain. 90 day and 1 year mortality was 0% in each domain. The recurrence rate was 21.2% with the median time to recur being 18 months. TGN Hypoesthesia was a predictor for long term complete pain relief (p = 0.0019). Advancing age was weakly significant for recurrence (p = 0.075). The absence of vessel contact on pre-op MRI for recurrence was not significant (p = 0.255). Patients with intraoperative vessel contact were less likely to experience recurrence compared to those without vessel contact (p = 0.012). The presence of venous contact without arterial contact showed the highest recurrence rate (45.5%) (p = 0.056). Conclusions MVD is an effective and safe surgery which has immense potential in curing TGN. Vessel contact in pre-operative imaging is not crucial for a good outcome. The presence of TGN Hypoesthesia a predictor in a good long-term outcome whilst the presence of venous contact intra-operatively is an important predictor in a poor outcome.