Enhanced Recovery after Surgery (ERAS) Protocol for Microvascular Decompression in Trigeminal Neuralgia: A Retrospective-Matched Cohort Study

Mohammadmahdi Sabahi; Hadi Sultan; Shadi Bsat; Abdulrahman Albakr; Badih Adada; Hamid Borghei-Razavi

doi:10.1055/s-0045-1803388

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J Neurol Surg B Skull Base 2025; 86(S 01): S1-S576
DOI: 10.1055/s-0045-1803388

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Enhanced Recovery after Surgery (ERAS) Protocol for Microvascular Decompression in Trigeminal Neuralgia: A Retrospective-Matched Cohort Study

Authors

Mohammadmahdi Sabahi

¹Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, United States
Hadi Sultan

²Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, United States
Shadi Bsat

¹Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, United States
Abdulrahman Albakr

¹Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, United States
Badih Adada

¹Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, United States
Hamid Borghei-Razavi

¹Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, United States

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Background and Objective: Microvascular decompression (MVD) is an effective surgical treatment for trigeminal neuralgia (TN), especially when medical therapy does not result in adequate pain control. Despite its efficacy, improvements can be made in the perioperative period to reduce hospital length of stay, enhance patient experience, improve outcomes, and reduce costs. An enhanced recovery after surgery (ERAS) protocol was implemented for patients and a retrospective cohort study was used to compare outcomes with non-ERAS MVD patients.

Methods: In this matched cohort analysis, a total of 240 patients were initially included. After 1:1 propensity score matching, 130 patients were selected for the main analysis, with comorbidities and demographic factors controlled for in the comparison.

Results: ERAS-treated patients had significantly reduced hospital length of stay (p < 0.001) compared to the control group with a mean of 1.46 and 2.95 days, respectively. Additionally, ERAS patients had similar post-operative Barrow Neurological Institute (BNI) pain scores to non-ERAS patients, with significantly lower verbal pain scores (p = 0.034). Patients in the ERAS group experienced significantly lower rates of transient postoperative hearing loss (p = 0.028) compared to controls. In a subanalysis of patients in the ERAS group who were discharged at 24 hours, these patients reported lower postoperative verbal pain levels (p = 0.003) compared to non-ERAS patients. In another subanalysis of ERAS patients discharged at 48 hours, no significant difference in outcomes was detected compared to non-ERAS patients. An ANCOVA comparing postoperative pain scores (BNI and verbal pain) between the ERAS and non-ERAS groups controlled for length of stay, age, duration of symptoms, and preoperative pain scores, and found no significant difference between the ERAS and non-ERAS groups ([Tables 1] [2] [3] [4]).

Conclusion: Implementation of this ERAS protocol for MVD has significantly reduced the length of stay with similar, if not improved, pain levels and rates of transient post-operative hearing loss compared to non-ERAS patients.