Pain Outcomes Following Endoscopic Microvascular Decompression for Trigeminal Neuralgia Based on Vascular Compression Type

Rachel Blue; Andrew I. Yang; Sonia Ajmera; Michael Spadola; Susanna Howard; Anissa Saylany; Svetlana Kvint; Alexander Harber; Megan Daly; Emily Shekhtman; Anjana Nair; Riddhi Deshpande; John Y.K. Lee

doi:10.1055/a-2065-9650

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2024; 85(03): 287-294
DOI: 10.1055/a-2065-9650

Original Article

Pain Outcomes Following Endoscopic Microvascular Decompression for Trigeminal Neuralgia Based on Vascular Compression Type

Rachel Blue

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Andrew I. Yang

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Sonia Ajmera

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Michael Spadola

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Susanna Howard

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Anissa Saylany

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Svetlana Kvint

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Alexander Harber

²Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Megan Daly

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Emily Shekhtman

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Anjana Nair

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

Riddhi Deshpande

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

,

John Y.K. Lee

¹Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

› Author Affiliations

Abstract

Background Arterial compression of the trigeminal nerve at the root entry zone has been the long-attributed cause of compressive trigeminal neuralgia despite numerous studies reporting distal and/or venous compression. The impact of compression type on patient outcomes has not been fully elucidated.

Objective We categorized vascular compression (VC) based on vessel and location of compression to correlate pain outcomes based on compression type.

Methods A retrospective video review of 217 patients undergoing endoscopic microvascular decompression for trigeminal neuralgia categorizing VC into five distinct types, proximal arterial compression (VC1), proximal venous compression (VC2), distal arterial compression (VC3), distal venous compression (VC4), and no VC (VC5). VC type was correlated with postoperative pain outcomes at 1 month (n = 179) and last follow-up (mean = 42.9 mo, n = 134).

Results At 1 month and longest follow-up, respectively, pain was rated as “much improved” or “very much improved” in 89 69% of patients with VC1, 86.6 and 62.5% of patients with VC2, 100 and 87.5% of patients with VC3, 83 and 62.5% of patients with VC4, and 100 and 100% of patients with VC5. Multivariate analysis demonstrated VC4 as a significant negative of predictor pain outcomes at 1 month, but not longest follow-up, and advanced age as a significant positive predictor.

Conclusion The degree of clinical improvement in all types of VC was excellent, but at longest follow-up VC type was not a significant predictor out outcome. However distal venous compression was significantly associated with worse outcomes at 1 month.

Keywords

vascular compression - trigeminal neuralgia - microvascular decompression - endoscopic - arterial compression - venous compression

Full Text

References

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