793 Sole Arterial Versus Venous Compression in Trigeminal Neuralgia

Abstract

INTRODUCTION: The majority of trigeminal neuralgia (TN) patients present with trigeminal nerve compression from the superior cerebellar artery. However, pain outcomes in patients with sole venous compression are not well understood. METHODS: We retrospectively reviewed 1020 patients undergoing microvascular decompression at our institution, identifying patients with either sole arterial or venous trigeminal nerve compression. We dichotomized patients into arterial or venous compression groups and obtained presenting characteristics, length of stay, and postoperative complications for each case. Pain outcomes were collected for each patient preoperatively and immediately postoperatively, in addition at 3-month, 6-month, 1 year, and >1 year follow up for each case via Barrow Neurological Index (BNI) pain scores. Statistical differences were calculated via Chi-squared tests and t-tests. RESULTS: Of 1020 patients, 648 (63.5%) had either sole arterial or venous compression of the trigeminal nerve. 514 of these cases demonstrated arterial compression, as opposed to 134 with only venous compression. Patients in the venous compression group were significantly younger than those in the arterial group. There were no significant differences in presenting comorbidities, ICU admission, length of stay, and postoperative complications between groups. Compared to the arterial compression group, patients with sole venous compression demonstrated significantly worse preoperative (p < 0.001), 3-month follow-up (p = 0.001), 6-month follow-up (p < 0.001), 1-year follow-up (p =< 0.001), and >1-year follow-up BNI scores (p = 0.001). Patients with venous compression were more likely to have recurrent pain (p = 0.047) and demonstrated significantly lower time to recurrence than the arterial compression group (p = 0.001). CONCLUSIONS: Patients with sole venous compression of the trigeminal nerve are more likely to have worse pain outcomes following MVD compared to those with only arterial compression, including both likelihood of pain recurrence, and time to recurrence