Prevalence and Trends of Surgical Intervention for Trigeminal Neuralgia in the Inpatient Setting in the United States: Analyses from a National Database from 2002–2015

Introduction: Trigeminal neuralgia is a debilitating neurological condition characterized by sharp, stabbing pain in the distribution of the trigeminal nerve and its branches. For trigeminal neuralgia that is refractory to medical therapy, surgery is generally indicated. The three main surgical techniques used to address trigeminal neuralgia are microvascular decompression (MVD), percutaneous rhizotomy or balloon compression, and stereotactic radiosurgery. Herein, we sought to assess the prevalence of trigeminal neuralgia among inpatient admissions, utilization of surgical intervention, and trends of utilization of common surgical approaches for TN using a national inpatient database.

Methods: The National Inpatient Sample (NIS) was queried for all patients with trigeminal neuralgia using international classification of disease 9th revision clinical modification (ICD-9-CM) diagnosis code (350.1) between the 1st quarter of 2002 and the 3rd quarter of 2015. Cases were also classified into surgical groups using ICD-9 procedure codes (ICD-9-PCS) including MVD (ICD-9-PCS code: 04.41, 04.02, 04.42, 02.06, 01.24, 01.25, 01.23), percutaneous procedures (04.2, 04.81, 99.29), and stereotactic radiosurgery (92.30, 92.31, 92.32, 92.33, 92.39). Using weighted discharge methodology, national estimates for prevalence, primary admissions, and utilization of each surgery type were computed.

Results: A total of 405,445 patients with trigeminal neuralgia were identified between the 1st quarter of 2002 and the 3rd quarter of 2015. Using weighted discharges, the average prevalence of trigeminal neuralgia among inpatient admissions was found to be 63.8 per 100,000. Additionally, prevalence was found to increase from 54.9 per 100,000 in 2002 to 76 per 10,000 in 2015. For subsequent analysis, patients with a primary diagnosis of trigeminal neuralgia were analyzed. A total of 67,768 patients had a primary diagnosis of trigeminal neuralgia. Of these, 41,473 (61.2%) underwent a surgical procedure. The percent utilization of surgical intervention for trigeminal neuralgia increased from 59.7% cases in 2002 to 69.1% in 2015. Of the cases undergoing a surgical intervention for trigeminal neuralgia, an MVD was performed for the majority of patients (87%, n = 36,083) followed by percutaneous procedures (7.3%, n = 3,036) and stereotactic radiosurgery (7.1%, n = 2,940). Furthermore, the percent utilization of MVD among patients undergoing surgical intervention increased form 67.3% in 2002 to 98% in 2015, the percent utilization of percutaneous procedures fell from 17.9 to 2%, and the percent utilization of stereotactic radiosurgery fell from 15.5 to 0.4%. When stratified by region, hospitals in the South saw the most significant increase in utilization of MVD (59.7% in 2002 to 99.4% in 2015).

Conclusion: While there are several modalities to treat trigeminal neuralgia, surgical management of the disease has increased in its utilization. The trends within surgical management of trigeminal neuralgia have also been rapidly evolving over the past two decades with a steady trend toward microvascular decompression.

Publication History

Article published online:
12 February 2021