Introduction: Microvascular Decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GN). Despite its success across a variety of patients and indications, MVD carries risk of complications, including posterior fossa hemorrhage, stroke, and cranial nerve injury. In this study, we examine outcomes following MVD and identify risk factors associated with adverse outcomes.
Methods: A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was performed, with CPT Code 61458 (craniotomy, suboccipital; for exploration or decompression of cranial nerves) queried between 2007 and 2014. Patient demographics, preoperative comorbidities, and 30-day outcomes were analyzed. Univariate and multivariate regression analyses were performed to identify predictors of reoperation and adverse events.
Results: 506 craniotomies were studied, with 406 for TN, 91 for HFS, and 9 for GN. 19 (5.4%) instances of 30-day readmission were reported, with 14 (2.8%) patients returning to the OR. The most common reoperations reported included CSF leak repair, seen in 5 patients, followed by wound revision in 3 and shunt placement in 1. No incidences of death or hemorrhage requiring operation were reported. The most common medical risk factor was obesity, seen in 183 patients (36.2%). Obesity was associated with reoperation risk (p=0.044, Fisher’s Exact Test), while diabetes was related to risk of reoperation (p=0.011) and readmission (p=0.002). Age, operative time, and indication for surgery (TN, HFS, or GN) were not associated with significant differences in outcomes.
Conclusions: Microvascular Decompression (MVD) is a common and effective treatment for refractory TN, HFS, and GN, with a relatively safe profile and low risk of reoperation (2.8%) similar to previous reports in the literature[1]. Advanced age was not found to be associated with worse outcomes. Obesity and diabetes, however, are associated with increased risk of reoperation and readmission and may warrant additional precautions.
Patient Care: Microvascular Decompression (MVD) is a common and effective treatment for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. Although relatively safe, complications do occur at low frequency. Because of the low incidence of complications, analysis of large, systemic databases like the ACS-NSQIP are useful to further characterize the incidence of poor outcomes, including readmission and return to the operating room. This study contributes to a growing body of literature derived from the ACS-NSQIP database to provide a summated description of MVD performed across a variety of institutions and the risk factors associated with poor outcomes.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Characterize common complications following Microvascular Decompression (MVD) and the overall complication rate.
2) Recognize common risk factors in the MVD population, and factors that place patients at elevated risk for complications.
3) Identify the NSQIP Database as a research tool to study the outcomes of neurosurgical operations.
References: 1. Barker FG, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. NEJM. Apr 1996; 334(17):1077-1083.