Risk Factors for Outcomes After Microvascular Decompression for Trigeminal Neuralgia

Abstract

Microvascular decompression (MVD) has been the most effective long-term surgical treatment of trigeminal neuralgia (TN). However, the risk factors for poor pain control after MVD are not fully understood. A total of 184 patients with typical TN who had undergone MVD at our institution from January 3, 2008 to January 3, 2016 were enrolled in the present study. The data were collected from the electronic operative records and case notes and retrospectively analyzed. Patients were followed up at the outpatient department or by telephone at a minimum of 3 months and a maximum of 48 months postoperatively. Of the 184 patients enrolled in the present study, 72.3% had had freedom from pain after MVD and 27.7% had experienced poor pain control at the follow-up examinations (minimum, 3 months; maximum, 48 months). The risk factors for poor pain control after MVD using binary logistic regression and receiver operating characteristic curve analysis included younger age (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.82-0.99; P=0.028; area under the curve [AUC], 0.774), poor preoperative pain control (Barrow Neurological Institute score >IV; OR, 52.03; 95% CI, 6.44-420.16; P < 0.001; AUC, 0.858), intraoperatively detected multivessel compression (OR,2.49; 95% CI, 3.10-46.59, P < 0.001; AUC, 0.871). Furthermore, combined compression of the superior cerebellar artery and petrosal vein was an independent risk factor predicting a poor outcome after MVD (OR, 5.69; 95%CI, 33.78-2579.03; P < 0.001; AUC, 0.812). Younger patients with TN had worse long-term pain outcomes after MVD. The additional factors associated with postoperative recurrence included poor preoperative pain control (Barrow Neurological Institute score >IV) and multivessel compression. Furthermore, combined compression of the superior cerebellar artery and petrosal vein was associated with worse outcomes.