Mikrovaskuläre Dekompression bei Patienten mit Trigeminusneuralgie: Langzeitergebnis und postoperative Lebensqualität

Microvascular decompression (MVD) is usually considered as the treatment of choice for drug-resistant classical trigeminal neuralgia. This study aims to demonstrate the impact of microsurgical therapy on the clinical outcome and pain-related quality of life.

In a retrospective analysis of 142 surgeries for MVD in 126 patients (mean age at surgery 62.9 years; female 61.3%, male 38.7%) performed at a single institution between 2001 and 2020, clinical data, intraoperative findings, perioperative course and postoperative outcome were reviewed. To analyze the postoperative quality of life, 39 patients with a follow-up of at least 5 years could be recruited for additional assessment based on validated questionnaires: Numeric Rating Scale (NRS), Short Form (SF)-12, Penn Facial Pain Score (PFPS) and additional questions about dental health/perioperative issues. Mean duration of symptoms before surgery was 7.7 years; mean follow-up was 4.2 years. Preoperatively, more than 63% of the patients reported side effects due to pain medication and 94.4% suffered from intolerable pain despite maximal medication.

Intraoperatively, a neurovascular conflict was identified in 92.3% (artery 39.4%, vene 10.6%, both 42.3%). Arachnoid adhesions affected the trigeminal nerve in 26.8%, no conflict was found in 4%. Perioperative complications occurred in 6.3% (n=9): Rhinoliquorrhea 2.1%, bleeding, infarction, CSF fistula 0.7% each. Neurological symptoms were persistent in 7.0% (n=10): Mild facial hypoesthesia 4.2%, hearing impairment 2.8%, dizziness/gait disturbance 1.4 %. There was no perioperative mortality. Facial pain resolved completely after surgery in 95.8%. Three months after surgery, 80% of the patients reported freedom of pain and additional 12.3% a significant reduction. Most patients had no need for further medical treatment, but 29.5% continued medication. In the long-term course, in 12.7% trigeminal pain recurred after a pain free mean period of 3.5 years. Re-MVD resulted in a favorable outcome. Pain assessment confirmed a significant improvement of facial pain systematically quantified by the NRS and PFPS. The quality of life (SF-12) due to pain control and medication retrieval also significantly improved after surgery.

MVD is an effective treatment in primary and recurrent trigeminal neuralgia with low permanent morbidity. Long-term pain control is favorable and is associated with a significant improvement of postoperative quality of life.