Introduction: For 75% of patients with Trigeminal Neuralgia (tic douloureux), the frequent lancinating pains can be controlled with medications. For the other 25% who’s pain is unable to be controlled or who experience intolerable side effects from drug therapy, one of the mainstays of surgical treatment is Microvascular Decompression (MVD). Often, a vascular loop is noted at the trigeminal nerve’s root entry zone. Previous studies have not investigated a possible correlation between the type of compression noted at surgery and facial pain outcomes. We hypothesized the more compression noted at the time of surgery would correlate with better facial pain outcomes.
Methods: A retrospective chart review at an academic referral center between January 2002 and January 2012 identified a total of twenty-eight patients who underwent MVD in which adequate follow up and intraoperative photographs were available. Intraoperative images were examined for these patients to confirm the type of vascular compression (none, venous, arterial and venous, or arterial). Outcome was defined as excellent (no pain, no medications), good (no pain, still requiring medications), fair (>50% decrease in pain), and poor (<50% decrease in pain or secondary surgery required).
Results: The average age of patients were 53.2±14 (14-73) (57% female). Right-sided procedures were performed on 57% of the patients. The type of vascular compression found was None=2, Vein only=6, Artery and Vein=4, and Artery only=25. Percentage of excellent outcomes for the types of compression were Nothing=50%, Vein Only=100%, Artery Only=56%, and Artery and Vein=75%.
Conclusions: Microvascular decompression outcomes did not appear to be related to the type of compression noted at the time of surgery. This finding may be limited by the low number of patients in the categories outside of arterial compression only.
Patient Care: This research address one of the most common questions patients considering microvascular surgery are keen to ask, does the type of vascular compression found during the surgery help predict the amount of facial pain relief they will experience. At this time there does not appear to be a pattern between compression type and outcome. However, this research provides the community with a starting point for further inquiry into this often asked question.
Learning Objectives: By the conclusion of this session, participants should be able to 1.) Counsel patients considering Microvascular Decompression surgery for trigeminal neuralgia that there currently does not appear to be a relationship between the type of vascular compression and facial pain outcome in MVD, 2.) Practitioners should refrain from providing prognostic indications to patient’s and patient families based upon level of compression noted at the time of surgery, 3.) As data collection continues and the number of patients with vascular compression other than arterial are followed, an outcome pattern may emerge.