Retractorless Microvascular Decompression for Trigeminal Neuralgia: Technical Nuances, Outcomes, and Impact on Hearing Loss

Background: Operative microsurgery of skull base lesions without the use of fixed retractors has gained increased popularity due to less morbidity and brain injury from retractor-induced complications. In microvascular decompression procedures, cerebellar retraction can increase the risk of postoperative hearing loss and cerebellar injury. The authors present a series of patients with trigeminal neuralgia (TN) who underwent a retractorless microvascular decompression (RMVD). The operative nuances and technical pearls are described and assessment of pain relief and postoperative complications are reported.

Methods: A retrospective chart review was performed on 48 patients diagnosed with TN and treated by RMVD. Data were extracted regarding patient demographics, affected trigeminal branches, intra-operative and postoperative complications, degree of pain relief, and pain recurrence.

Results: Forty-eight patients (33 females, 15 males) underwent RMVD for TN. Average age of the patient cohort was 56 years old (SD ±11.7). Patients over 60 years of age constituted 49.7% (n = 23) of the cohort. Pain distribution was most commonly in the V2 (64.6%) and V3 (68.8%) regions, with fewer patients complaining of V1 (18.8%) pain. Intraoperatively, the SCA was found to be the most common culprit of nerve root compression composing 59.3% of cases. Forty-five patients (93.7%) achieved a BNI grades I–II (81.3% grade I, 12.5% grade II). One patient achieved a grade III, two patients were poorly or completely unresolved with BNI grades IV and V, respectively. One patient had bilateral procedures, one patient underwent radiosurgery and was lost to follow-up, and 5 patients had a repeat RMVD for pain free recurrence. All five patients (100%) with repeat RMVD improved postoperatively to a BNI Grade I. Average follow-up of patients was 15.9 months. Average length of stay was 2.84 days (SD ±1.2). There were no complications of facial palsy, trigeminal dysfunction, radiographic or clinical cerebellar injury or CSF leakage. One patient had postoperative hearing loss (2.1%).

Conclusion: RMVD is a safe and effective strategy for surgical treatment of TN. The avoidance of fixed retractors can minimize postoperative complications and morbidities.

Die Autoren geben an, dass kein Interessenkonflikt besteht.