Outcomes after microvascular decompression for sole arterial versus venous compression in trigeminal neuralgia.

Abstract

In most cases of trigeminal neuralgia (TN), the trigeminal nerve is compressed by the arterial vasculature. We sought to address the current gap in understanding of pain outcomes in patients with sole arterial versus sole venous compression.We retrospectively reviewed all patients undergoing microvascular decompression at our institution, identifying patients with either sole arterial or venous compression. We dichotomized patients into arterial or venous groups and obtained demographics and postoperative complications for each case. Barrow Neurological Index (BNI) pain scores were collected preoperatively, postoperatively, and at final follow-up, as well as recurrence of pain. Differences were calculated via Chi-squared tests and t-tests. Ordinal regression was used to account for variables known to influence TN pain. Kaplan-Meier analysis was used to determine recurrence-free survival.Of 1044 patients, 642 (61.7%)had either sole arterial or venous compression. 472 of these cases demonstrated arterial compression, and 170 displayed sole venous compression. Patients in the venous compression group were significantly younger (p<0.001). Patients with sole venous compression demonstrated worse preoperative (p=0.04) and final follow-up (p<0.001) pain scores. Patients with sole venous compression had significantly higher rate of pain recurrence (p=0.02) and BNI score at pain recurrence (p=0.04). On ordinal regression, venous compression was found to independently predict worse BNI pain scores (OR= 1.66, p=0.003). Kaplan-Meier analysis demonstrated a significant relationship between sole venous compression and increased risk of pain recurrence (p=0.03).TN patients with sole venous compression demonstrate worse pain outcomes following MVD compared to those with only arterial compression.

View details for DOI 10.1016/j.wneu.2023.02.090

View details for PubMedID 36889635