Long-Term Follow-Up of Microvascular Decompression in the Treatment of Trigeminal Neuralgia

Objective: To determine the long-term success of microvascular decompression (MVD) in the treatment of trigeminal neuralgia.

Methods: A prospective longitudinal cohort study of patients with trigeminal neuralgia who underwent posterior fossa craniectomy with the intention to treat by MVD was performed. Analysis was by postal questionnaire survey and review of collected data.

Results: Two hundred sixty-two patients underwent surgical intervention with 265 operative procedures undertaken (204 MVDs, 21 partial nerve sections, 8 tumor resections, 3 explorations). The mean age at surgery was 55.9 years. The mean interval at follow-up was 108 months. Two hundred eight and 174 patients were followed up> 24 and 60 months, respectively. Forty-seven patients died during follow-up (mean, 102 months). Overall, 175 patients (67%) remained pain-free, 42 (16%) had minor recurrences, 42 (16%) had major recurrences, 2 (0.7%) had no improvement, and 1 (0.3%) died during the postoperative period. Two hundred twelve patients had definite operative findings (204 vascular compression, 8 tumors) while 50 patients had indefinite findings. Twenty-one patients with indefinite findings underwent partial nerve section, and of them, 13 (61%) remained pain-free. Further analysis was performed in respect to patients who were followed up > 5 years, those who died, and those who developed bilateral pain.

Conclusion: The study continues to demonstrate the long-term success of MVD in the treatment of trigeminal neuralgia and highlights the importance and use of a long-term prospective follow-up database in the assessment of a chronic neurological disorder.