Duration of Trigeminal Neuralgia Is the Risk Factor for Failure of Microvascular Decompression

Objectives: Initial therapy of trigeminal neuralgia (TN) is carbamazepine. Surgical therapy such as microvascular decompression (MVD) of only recommended with medical treatment failure of with nontolerable adverse effects. But we hypothesized that early microvascular decompression has better clinical outcome, which might contradict clinical guidelines.

Methods: A multicenter retrospective data analysis of trigeminal neuralgia patients receiving MVD was performed. Primary outcome was the rate of pain-free patients at last follow-up. At final follow-up, a telephone interview for patients’ satisfaction was conducted.

Results: A total of 970 patients from 20 European institutions were analyzed. Follow-up data were obtained from 881 (91%). 414 patients were male (43%) mean age was 61 years. Mean duration of symptoms until surgery was 70.6 months (5.8 years). From 858 patients with available imaging data 615 (72%) had a visible conflict on the MRI. 62% of patients were pain free at last follow-up. Facial hypoesthesia was the most common complication and was seen in 18% of patients. There were no mortalities. Telephone interview was conducted with 699 (72%) patients. Of those, 599 (85%) were satisfied with surgery and 459 (65%) would have preferred earlier surgery. Regression analysis revealed that only preoperative duration of symptoms correlated with treatment failure (p = 0.012).

Conclusion: Microvascular decompression for trigeminal neuralgia is a safe and effective treatment method. Early MVD has the best chance of good clinical outcome.