Trigeminal microvascular decompression for medically refractory Short-lasting Unilateral Neuralgiform Headache Attacks: a single-centre retrospective analysis

This analysis aims to evaluate the sustained effectiveness of trigeminal microvascular decompression (MVD) in patients with medically refractory Short-lasting Unilateral Neuralgiform Headache Attacks (SUNHA) who demonstrate trigeminal neurovascular conflict (NVC) ipsilateral to the painful side. This is a retrospective single-centre analysis of prospectively collected data conducted between September 2012 and March 2025 to investigate the efficacy and safety of trigeminal MVD in consecutive refractory chronic SUNHA patients suitable for surgery. All patients underwent a magnetic resonance imaging (MRI) with specific trigeminal sequences before surgery. The 5-point Barrow Neurological Institute (BNI) pain intensity score was used to quantify the response to surgery. Patients with a BNI of 1-2 at the final post-surgery follow-up were considered responders. The study group consisted of 19 SUNHA patients (n=7 female), with a mean age of 58 (±12, range 35-81), refractory to medical therapy (BNI score=5), who underwent trigeminal MVD. Of the 18 patients included in the analysis, trigeminal NVC with morphological changes was found in 13 patients (72.2%). Post-operatively, 16 patients (89.0%) were responders. Two patients had a BNI score=3, reflecting a partial improvement (11.1%). The mean post-surgery follow-up was 54.3 months (±36.7, range 2-163 months). At the final follow-up, 13 patients remained responders (72.2%). One patient reported transient post-operative dizziness and one patient reported pain in the incision site. Trigeminal MVD may be a safe and effective treatment modality for those patients with medically refractory SUNHA with MRI evidence of trigeminal NVC with morphological changes.