Introduction: Trigeminal Neuralgia (TN) is a pain disorder characterized by paroxysmal lancinating pain along the distribution of the trigeminal nerve. Mounting clinical evidence supports the neurovascular compression (NVC) theory, suggesting vascular compression results in the manifestation of debilitating pain. Microvascular Decompression (MVD) is the only known surgical intervention that directly address this proposed etiology.

Methods: A retrospective review of patient records at the Johns Hopkins Hospital from 1998 to 2015 revealed 942 patients with TN and 500 patients who underwent MVD. A total of 306 patients who underwent MVD initially and 175 patients who underwent salvage MVD were included for analysis. Demographics, pre-operative interventions, pain outcomes, pre- and post-operative sensory outcomes, and complications were collected.

Results: Patients who underwent salvage MVD were older (55.22 years versus 49.98 years, p < 0.0001), and experienced symptoms longer (7.22 years versus 4.45 years, p <0.0001). Patients who underwent MVD initially experienced improved pain relief and no pain relief rates compared to those who had salvage MVD (95.8% and 4.2% versus 90.3% and 9.7%, respectively, p=0.0041). Patients that underwent MVD initially had significantly lower rates of facial numbness in the pre and post-operative period compared to salvage MVD patients (p < 0.0001). The number of complications between both groups was similar (p = 0.4572).

Conclusions: Our results suggest that patients who underwent procedures prior to MVD experienced less pain relief and a higher incidence of facial numbness despite similar rates of complications as compared to patients who underwent MVD as their 1st surgical intervention.

Patient Care: Pain secondary to trigeminal neuralgia shows a robust response to microvascular decompression whether it is the first surgical intervention attempted in patients with TN or if it is a subsequent operation. As such MVD is a safe option for patients with TN and may be considered as an initial intervention

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the pain outcomes, complication rates, facial sensation changes, and time to recurrence for patients undergoing MVD as their first surgical intervention versus MVD as a subsequent surgical intervention

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