Microvascular Decompression for Trigeminal Neuralgia May Yield Lasting Effect

A prospective, observational study found that microvascular decompression for the treatment of classical and idiopathic trigeminal neuralgia was effective and had a high chance of eliciting a lasting effect through 2 years, according to study results published in The Journal of Headache and Pain.

Patients (N=115) with classical (n=61) and idiopathic (n=39) trigeminal neuralgia with neurovascular contact were recruited for this study (ClinicalTrials.gov Identifier: NCT04445766) at the Danish Headache Center between 2012 and 2018. The patients underwent microvascular decompression using a modified Jannetta procedure performed. Up to 24 months after surgery, the patients were evaluated for pain relief, complications, and recurrence. An excellent outcome was defined as complete pain relief with no medication use. Recurrence was defined as the return of pain after being pain-free at 12 months.

The mean age of study participants who underwent microvascular decompression was 62.0 (95% CI, 59.6-64.4) years, and 54% reported experiencing continuous pain.

At 24 months, 70% had an excellent outcome. Treatment failure due to subsequent neurosurgery before the 24-month follow-up occurred among 6%, no pain relief was reported among 4%, and aggravation of pain occurred among 2%.

Men were more likely to have a clinically significant outcome than women (odds ratio [OR], 4.9; 95% CI, 1.9-12.8; P =.001), and patients with classical trigeminal neuralgia were more likely to have an excellent outcome than patients with idiopathic trigeminal neuralgia (OR, 2.5; 95% CI, 1.1-6.0; P =.036).

Minor recurrence (eg, occasional pain, no pain but daily use of medication necessary, occasional pain requiring medication) occurred among 10% and major recurrence (eg, poor pain relief, no pain relief, pain aggravation) occurred among 5%.

At 12 and 24 months, the most frequent complications were permanent hearing impairment (10% and 9%), permanent ataxia (7% and 5%), permanent severe hypoesthesia (7% and 6%), cerebellar or brainstem infarction (5% and 5%), and cerebrospinal fluid leak (5% and 0%), respectively.

Risk for a major complication was associated with poor or failed surgical outcomes (P =.004).

In a patient satisfaction survey, 94% indicated they would recommend microvascular decompression to other patients, and 79% reported being satisfied with the procedure. Among the patients who experienced a major complication (n =33), 82% said they would recommend microvascular decompression, and 52% reported being satisfied with the procedure.

A major limitation of this study was its follow-up duration.  Additional study is therefore needed to determine the duration of pain relief from microvascular decompression.

These data indicate that microvascular decompression is an effective treatment for patients with classical or idiopathic neurovascular trigeminal neuralgia, with persistent pain relief through 2 years. According to the study authors, “[Microvascular decompression] should be considered in patients with [trigeminal neuralgia] where medical treatment is ineffective or causing significant side effects.”