Can Vascular Compression Be Reliably Identified on Preoperative Images in Microvascular Decompression Cases?

Microvascular decompression (MVD) is among the most direct and curative interventions for treating cranial nerve neuralgias. However, MVD outcomes are varied. The current literature suggests recurrence rates can approach 30%. Evidence of neurovascular compression on preoperative imaging has been shown to predict better surgical outcomes. In our study, we evaluated our institution's experience with microvascular decompression and pre-operative imaging studies. We performed a retrospective review of patients who underwent microvascular decompression for a cranial nerve neuralgia and compared the pre-operative assessment of imaging with the operative findings. We are currently performing a blinded analysis of our preoperative imaging with our neuroradiology colleagues to eliminate bias from the clinical history and physical exam. In our preliminary results, we have a sample size of 227 patients with 254 total surgeries (17 reoperations and 10 surgeries of the contralateral side). The majority of surgeries were for trigeminal neuralgia (197) with a small component of hemifacial spasm (31) and lower cranial nerve neuralgias (13). We had 4 total intra-operative complications (3 related to major vascular injury and 1 related to decrease in facial nerve potentials with associated post-operative weakness). A total of 75 total surgeries had a named preoperative vessel. Of these, 80% were the correct offending vessel as described in the operative report. Venous compression was identified in 126 cases although mostly in conjunction with arterial compression; isolated venous compression was found only 38 times. We had 151 patients present to 3 months of follow-up. At this visit, we had a recurrence rate of 21%. Of those patients who had the vascular offender correctly identified preoperatively, 38 of the 60 had data at 3-month follow-up. Of these 38 patients, 32 were pain free (84% resolution rate). We are optimistic our forthcoming comparison between blinded neuroradiologists, and intraoperative findings can offer a fuller picture of preoperative evaluations for microvascular decompression. Given our robust sample size, we expect our complete findings to provide a more comprehensive understanding of cranial nerve neuralgias and outcomes with microvascular decompression.

Publication History

Article published online:
07 February 2025