Long-term outcomes of microvascular decompression for trigeminal neuralgia: the prognostic role of age and intraoperative neurovascular compression severity.

OBJECTIVE: To evaluate long-term pain outcomes and safety after microvascular decompression (MVD) for primary trigeminal neuralgia (TN) in a single-center cohort and to explore whether age and intraoperative neurovascular compression severity were associated with favorable long-term pain relief. METHODS: We retrospectively reviewed 134 consecutive patients with primary TN who underwent first-time MVD between January 2016 and December 2018 at a single institution, with at least 36 months of follow-up. Pain outcomes were assessed using the Barrow Neurological Institute (BNI) pain intensity scale. Postoperative complications, medication use, Kaplan-Meier analysis, and uni- and multivariable logistic regression were used to evaluate outcomes and associated factors. RESULTS: At 1 month after surgery, 95% of patients achieved favorable pain relief (BNI grades I-III). At the final follow-up, 77% maintained favorable pain relief, and 69 patients achieved complete pain relief (BNI grade I). Ninety-four patients reduced antiepileptic medication use by at least 50%, and 69 discontinued medication completely. The most common complications were dizziness (4.4%), facial numbness (2.9%), and hearing impairment (2.9%). Age ≥70 years and significant intraoperative neurovascular compression were independently associated with favorable long-term pain relief. CONCLUSIONS: In this retrospective single-center series, MVD was associated with durable pain relief, substantial medication reduction, and an acceptable complication profile. Age ≥70 years and significant intraoperative neurovascular compression were associated with favorable long-term pain relief in our cohort. These findings reflect institutional experience and may assist patient selection and counseling.