Microvascular decompression for trigeminal neuralgia, long-term follow-up results and assessment of possible prognostic factors: a single-center retrospective cross-sectional cohort study





trigeminal neuralgia, microvascular decompression, prognostic factors


Aim: Prognostic factors detection and analysis of long-term results of microvascular decompression for trigeminal neuralgia.

Materials and methods.  161 cases of trigeminal neuralgia (TN) treatment by MVD technique without preliminary invasive interventions within 10 years were analyzed. Two blocks of information were designed which included objective case data (8 factors) and patient satisfaction survey (5 questions). Follow-up minimal cut-off was 1 year (median 5.8 years). The primary end point is the proportion of pain free patients and BNI (Barrow Neurological Institute) score at last follow-up. The secondary end point is the assessment of possible risk factors of  treatment failure: symptoms duration, decompression type, affected nerve branches, neurovascular conflict visible on MRI, different indications for surgery. Logit-regression analysis was carried out. Significance level was set at p<0,01.

Results. Among the studied factors as predictors for pain recurrence all but one failed to reach significance threshold. Conflict on MRI (p=0,231), involved nerve branches (p=0,340), indications for surgery (p=0,659), number of involved vessels (p=0,834), achieved decompression type (p=0,157), venous compression (p=0,143), gender (p=0,150), affected side (p=0,934) did not reach the significance level. For symptoms duration p=0,0012.

Conclusions. As a result of multifactorial analysis   of study results, the only significant prognostic factor for treatment failure (pain recurrence or worsening of obtained result) was symptoms duration at the time of surgery.


Manzoni GC, Torelli P. Epidemiology of typical and atypical craniofacial neuralgias. Neurol Sci. 2005;26 Suppl 2:s65-7. doi: 10.1007/s10072-005-0410-0

De Toledo IP, Reus JC, Fernandes M, Porporatti AL, Peres MA, Takaschima A, Linhares MN, Guerra E, Canto GD. Prevalence of trigeminal neuralgia A systematic review. J Am Dent Assoc. 2016;147(7):570-+. doi: 10.1016/j.adaj.2016.02.014.

Henschke N, Kamper SJ, Maher CG. The epidemiology and economic consequences of pain. Mayo Clin Proc. 2015;90(1):139-47. doi: 10.1016/j.mayocp.2014.09.010

Pearce JM. Trigeminal neuralgia (Fothergill's disease) in the 17th and 18th centuries. J Neurol Neurosurg Psychiatry. 2003;74(12):1688. doi: 10.1136/jnnp.74.12.1688

Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, Eide PK, Leal PRL, Maarbjerg S, May A, Nurmikko T, Obermann M, Jensen TS, Cruccu G. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019;26(6):831-49. doi: 10.1111/ene.13950

Araya EI, Claudino RF, Piovesan EJ, Chichorro JG. Trigeminal Neuralgia: Basic and Clinical Aspects. Curr Neuropharmacol. 2020;18(2):109-19. doi: 10.2174/1570159x17666191010094350.

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi: 10.1177/0333102417738202

Benoliel R, Zini A, Khan J, Almoznino G, Sharav Y, Haviv Y. Trigeminal neuralgia (part II): Factors affecting early pharmacotherapeutic outcome. Cephalalgia. 2016;36(8):747-59. doi: 10.1177/0333102415611406

Jorns TP, Zakrzewska JM. Evidence-based approach to the medical management of trigeminal neuralgia. Br J Neurosurg. 2007;21(3):253-61. doi: 10.1080/02688690701219175

Levin M. The International Classification of Headache Disorders, 3rd Edition (ICHD III) - Changes and Challenges. Headache. 2013;53(8):1383-95. doi: 10.1111/head.12189

Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL. Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute. Int J Radiat Oncol Biol Phys. 2000;47(4):1013-9. doi: 10.1016/s0360-3016(00)00513-7

Chen HI, Lee JY. The measurement of pain in patients with trigeminal neuralgia. Clin Neurosurg. 2010;57:129-33.

Riesenburger RI, Hwang SW, Schirmer CM, Zerris V, Wu JK, Mahn K, Klimo P, Jr., Mignano J, Thompson CJ, Yao KC. Outcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up. J Neurosurg. 2010;112(4):766-71. doi: 10.3171/2009.8.JNS081706

Kumar S, Rastogi S, Kumar S, Mahendra P, Bansal M, Chandra L. Pain in trigeminal neuralgia: neurophysiology and measurement: a comprehensive review. J Med Life. 2013;6(4):383-8

Antonini G, Di Pasquale A, Cruccu G, Truini A, Morino S, Saltelli G, Romano A, Trasimeni G, Vanacore N, Bozzao A. Magnetic resonance imaging contribution for diagnosing symptomatic neurovascular contact in classical trigeminal neuralgia: A blinded case-control study and meta-analysis. Pain. 2014;155(8):1464-71. doi: 10.1016/j.pain.2014.04.020

Haller S, Etienne L, Kovari E, Varoquaux AD, Urbach H, Becker M. Imaging of Neurovascular Compression Syndromes: Trigeminal Neuralgia, Hemifacial Spasm, Vestibular Paroxysmia, and Glossopharyngeal Neuralgia. AJNR American journal of neuroradiology. 2016;37(8):1384-92. doi: 10.3174/ajnr.A4683

de Lange EE, Vielvoye GJ, Voormolen JH. Arterial compression of the fifth cranial nerve causing trigeminal neuralgia: angiographic findings. Radiology. 1986;158(3):721-7. doi: 10.1148/radiology.158.3.3945746

Nurmikko TJ, Eldridge PR. Trigeminal neuralgia--pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001;87(1):117-32. doi: 10.1093/bja/87.1.117

Yoshino N, Akimoto H, Yamada I, Nagaoka T, Tetsumura A, Kurabayashi T, Honda E, Nakamura S, Sasaki T. Trigeminal neuralgia: evaluation of neuralgic manifestation and site of neurovascular compression with 3D CISS MR imaging and MR angiography. Radiology. 2003;228(2):539-45. doi: 10.1148/radiol.2282020439

Hilton DA, Love S, Gradidge T, Coakham HB. Pathological Findings Associated with Trigeminal Neuralgia Caused by Vascular Compression. Neurosurgery. 1994;35(2):299-303. doi: Doi 10.1227/00006123-199408000-00017

Love S, Hilton DA, Coakham HB. Central demyelination of the Vth nerve root in trigeminal neuralgia associated with vascular compression. Brain Pathol. 1998;8(1):1-11; discussion -2. doi: 10.1111/j.1750-3639.1998.tb00126.x

Heinskou TB, Rochat P, Maarbjerg S, Wolfram F, Brennum J, Olesen J, Bendtsen L. Prognostic factors for outcome of microvascular decompression in trigeminal neuralgia: A prospective systematic study using independent assessors. Cephalalgia. 2019;39(2):197-208. doi: 10.1177/0333102418783294



How to Cite

Naboichenko, A. G., Fedirko, V. O., Yehorov, M. V., Lisianyi, O. M., Onishchenko, P. M., Tsiurupa, D. M., Shust, V. V., & Lisianyi, A. O. (2021). Microvascular decompression for trigeminal neuralgia, long-term follow-up results and assessment of possible prognostic factors: a single-center retrospective cross-sectional cohort study. Ukrainian Neurosurgical Journal, 27(4), 10–15. https://doi.org/10.25305/unj.239697



Original articles