Abstract
PurposeControversies regarding venous compression and trigeminal neuralgia (TN) still exist. The study demonstrates our experience for microvascular decompression (MVD) in TN caused by purely venous compression. The goal was to identify prognostic anatomical or surgical factors that may influence the outcome.MethodsBetween 2004 and 2020, 49 patients were operated with purely venous compression. Average age was 58.4 years. Mean history of TN was 7.8 years. Microsurgical procedures included transposition or separation of the vein, coagulation, and division. Several features have been analyzed with respect to BNI scores.ResultsEvaluation on discharge revealed a complete pain relief in 39 (80%), partial improvement in 7 (14%), and no benefit in 3 (6%) patients. Facial hypesthesia was reported by 14 (28.6%) patients. Mean follow-up (FU) was 42.1 months. BNI pain intensity score on FU revealed 71.4% excellent to very good scores (score 1: 32 (65.3%); 2: 3 (6.1%)). BNI facial numbness score 2 could be detected in 13 patients (26.5%) during FU. There was no statistical relationship between immediate pain improvement or BNI pain intensity score on FU with respect to surgical procedure, size of trigeminal cistern, type of venous compression, venous caliber, trigeminal nerve indentation, or neurovascular adherence. BNI facial numbness score was dependent on type of venous compression (p < 0.05).ConclusionWe did not find typical anatomical features that could either predict or influence the outcome regarding pain improvement or resolution in any form. Neither classic microvascular decompression (interposition/transposition) nor sacrificing the offending vein made any difference in outcome.
Highlights
Vascular compression of the trigeminal nerve root by an arterial loop at the root entry zone (TREZ) as the main cause of trigeminal neuralgia (TN) is most frequent
We demonstrate our experience using the endoscopeassisted technique for microvascular decompression (MVD) in patients with TN caused by purely venous compression
The types of venous compression described by Inoue et al [7] were categorized
Summary
Vascular compression of the trigeminal nerve root by an arterial loop at the root entry zone (TREZ) as the main cause of trigeminal neuralgia (TN) is most frequent. A neurovascular conflict between the trigeminal nerve and a vein can be an acceptable cause of TN too. Barker et al reported in 1996 the high number of 151 patients in whom a vein only was expected to be responsible for TN [1]. Besides their good results, they and others mentioned a high rate. There is a small number of studies dealing with pure venous compression in TN [2, 4, 6, 7, 9–11]
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