Minimally invasive microvascular decompression for trigeminal neuralgia: results and complication avoidance in a consecutive series of patients

Objective: Microvascular decompression (MVD) represents a milestone for the treatment of trigeminal neuralgia (TN). Nevertheless, several complications still occur and may negatively affect the outcome. The authors recently proposed a minimally invasive technique, including endoscopic assistance in instances of intraoperative hidden corners, with which they were able to achieve good results in terms of pain relief and minimize overall complication rates. The aim of this study was to verify the short- and long-term efficacy of the proposed refinement of the standard MVD technique in terms of pain relief and reduction of complication rates. Methods: The authors analyzed the surgical and outcome data of 154 consecutive patients with TN over a 10-year period. Outcome variables included pain relief, facial numbness, muscular atrophy, local cutaneous occipital and temporal pain or numbness, cerebellar injury, hearing loss, cranial nerve deficits, wound infection, CSF leakage, recurrences, and mortality rate. The overall complication rate was defined as the occurrence of any of the aforementioned items. Results: A total of 154 consecutive patients were included in the study. Pain relief was achieved in 97.4% immediately after surgery, while 92.9%, 85.7%, and 83.1% of patients were pain free at the 1-year, 5-year, and last follow-up, respectively. The mean follow-up was 71.18 months (range 11-120 months). The overall complication rate was 5.8%, but only 1.3% of patients experienced permanent neurological complications. The CSF leakage rate was 3.2%. Two patients (1.3%) developed complete hearing loss, and another patient developed mild temporary dysfunction of the eighth cranial nerve. One patient experienced postoperative ataxia but completely recovered in 1 month. No other complication or death was observed. Conclusions: The proposed minimally invasive refinement of the standard MVD technique has been shown to be effective in maintaining excellent results in terms of pain relief, in both the short and long term, while minimizing the overall complication rate associated with this surgical approach.