Trigeminal neuralgia is one of the most severe pain sensation of human beings and is often not sufficiently manageable with pharmacotherapy. Microvascular decompression (MVD) is the most effective procedure for the long-term management of classical trigeminal neuralgia (TGN). The present study addresses complications in patients with TGN who underwent MVD, and evaluate the short- and long-term outcomes.

clinical data, imaging results, surgical methods and treatment efficacies including pain relief according to the Barrow Neurological Institute pain scale, complications and the medical treatment during the follow-up period of 102 patients with classical TN from January 2000 to December 2022 were retrospectively analyzed and reviewed.

A total of 102 patients (60 female and 42 male) with a mean age of 58.1 years and a mean follow-up of 78.6 months were included. 30 Patients (29.4%) had preoperatively a monotherapy with Carbamazepin or Oxcarbazepin, 63 (61.7%) with one add-on Therapy and nine patients with 3 or more drugs. The most common affected branches of the trigeminal nerve were the 2nd and 3rd in combination or alone in 98% of the cases. In all but one patient there was an evidence of neurovascular contact in the preoperative MRI. An osteoplastic trepanation was used in 22 patients and an osteoclastic one in 80 Patients. In 90 Patients an S-shaped incision was chosen and 12 Patients were operated through an c-shaped incision. 20 Patients showed muscle atrophy in the follow up. All of them were operated via an S-shaped incision. The most common vessel responsible for the neurovascular contact was the superior cerebellar artery in 68 cases. The most frequent complications were hypo- or anacusis in 6 patients, wound infection in 3, CSF fistula in 2, facial palsy in one and cerebellar hemorrhage in one patient. At the final follow-up visit, 89% of the patients had achieved significant relief of the pain (BNI Pain score 1 or 2) and 11% could reduce the medications significantly. The recurrence rate was 9%. After 4.7 years, 67.3% were still satisfied with no or occasional pain but without medications.

Microvascular decompression is an effective and safe therapy in patients with trigeminal neuralgia. Perioperative complications after MVD are comparable with the literature. Muscular atrophy, retroauricular hypoesthesia and headache are significantly more with S-shaped skin incision.