Sex-specific pain outcomes following microvascular decompression for trigeminal neuralgia. World neurosurgery Kilgore, C. B., So, R. J., Storm, K., Nair, S. K., Ran, K. R., Kalluri, A. L., Lim, M., Huang, J., Bettegowda, C., Xu, R. 2023


Trigeminal neuralgia (TN) is more prevalent among women. However, while microvascular decompression (MVD) is the most effective long-term surgical treatment for TN, it is unclear whether it is equally efficacious for men and women. We sought to characterize the relationship between sex and pain outcomes following MVD for TN.From 2007 to 2020, 938 unilateral TN patients were treated with MVD at our institution. Patient demographics, clinical characteristics, operative features, and pain outcomes were recorded. Differences between men and women were analyzed via t-test and Chi-squared analyses. A multivariate ordinal regression was used to establish significant predictors of pain outcome. Differences in time to pain recurrence were assessed via Cox proportional hazards and Kaplan-Meier non-parametric survival analysis.A majority (67%) of the 938 patients analyzed were female. Men and women presented with similar pre-operative pain severity (p=0.17). Female sex (p=0.048) and younger age (p=0.03) were independently associated with worsened BNI pain scores at three-month follow-up upon multivariate analysis. Women were also more likely to experience recurrence than men (p=0.01), and time to recurrence was shorter among women (p=0.02). Only female sex was independently associated with increased risk of post-operative pain recurrence upon multivariate Cox proportional hazards regression (p=0.01).Female TN patients undergoing MVD had worse pain outcomes, more frequent pain recurrence, and shorter time to recurrence. Our results indicate a sex-specific dimorphism in response to MVD among TN patients.

View details for DOI 10.1016/j.wneu.2023.02.074

View details for PubMedID 36828277