Comparative Analysis of Trigeminal Neuralgia Caused by Sole Arterial and Venous Compression: Clinical Features and Surgical Outcomes From 222 Cases

Abstract

Background: Compared with trigeminal neuralgia (TN) caused by arterial neurovascular conflict (NVC), the clinical characteristics and managements for TN with venous NVC are not well-established. This study aims to comparatively summarize the clinical features and surgical outcomes of microvascular decompression (MVD) for patients with TN caused by sole arterial and venous compression, with a particular focus on the morphological features of posterior cranial fossa (PCF).Methods: A total of 222 patients with TN caused by sole arterial NVC (188/84.7%) and venous NVC (34/15.3%) underwent MVD in our department from January 2014 to December 2018. The patient data were analyzed retrospectively. Particularly, we focused on the potential impact of PCF on surgical outcomes.Results: Compared with arterial NVC, V3 branch of the trigeminal nerve was more frequently involved in venous NVC (p = 0.009). The most common compression site was root entry zone for arterial NVC (68.6%) and midcisternal segment for venous NVC (76.5%) (p < 0.001). No serious post-operative complication was observed in the two groups. Both short- and long-term outcomes were relatively worse in venous NVC cases compared with arterial NVC cases (p = 0.001 and p = 0.030, respectively); and a dominantly higher rate of delayed cure was demonstrated in venous NVC cases (p < 0.001). TN patients with venous NVC revealed a more flat-shaped PCF than those with arterial NVC. Moreover, flat-shaped PCF morphometry was negatively correlated with surgical outcomes of TN patients with arterial NVC, but not with those of venous NVC cases.Conclusions: MVD is an effective and safe treatment for patients with TN caused by either arterial or venous NVC. Patients with a more flat-shaped PCF might be vulnerable to venous compression. Our study demonstrated that PCF morphometry only affected the surgical outcomes of patients with TN caused by arterial NVC, but not the outcomes of those with venous NVC.

Delayed pain relief in patients with trigeminal neuralgia following microvascular decompression: A single-central retrospective study

“…The other studies that have mentioned DR include Wang et al and Shi et al (9,25), in which they reported a DR rate of VO cases was higher than the rate of OA cases. Li et al ( 12) compared 45 patients with typical presentations and 17 patients with atypical presentations.…”

Multiple Vessel Compression of the Trigeminal Nerve Is Associated With Worse Outcomes in Trigeminal Neuralgia After Microvascular Decompression

“…Venous compression in TN has been shown to produce a more intractable pain phenotype compared with cases implicating arteries. In a 2021 study by Wang et al 19 investigating differences in outcomes after an MVD, both short-term and long-term pain outcomes were worse for patients with sole venous compression. In particular, 52.9% of 34 patients with sole venous compression experienced insufficient pain relief after their MVD, compared with 15.4% of 188 patients with sole arterial compression.…”

“…A similar result was found when reassessed at a more long-term follow-up interval. 19 In addition, morphological changes to the trigeminal nerve in TN cases have been found not only to differ based on the identity of the compressive vessel but also to be predictive of postoperative pain relief after MVD. 12…”

“…[5][6][7][8] Both arterial and venous compression of the trigeminal nerve has been identified in cases of classical TN, with arteries representative of the offending vessel in more than 75% of cases. [9][10][11] Morphological changes due to compression of the trigeminal nerve have been shown to differ based on the identity of the offending vessel. 9,12,13 Resultingly, pain outcomes in patients with TN also differ based on whether the compressive vessel is an artery or a vein, with venous compression generally associated with worse shortterm and long-term pain outcomes in patients with TN undergoing a microvascular decompression (MVD).…”

Trigeminal neuralgia due to intracranial venous reflux following central venous disease in a patient on hemodialysis: A case report

“…[ 12 ] The therapeutic effect of surgery is well established for cases caused by arterial compression; microvascular decompression cures the disease in 85% of cases. [ 14 ] In contrast, no surgical strategy has been established for cases without obvious arterial compression. [ 2 ] We present a case of TN without arterial compression in a patient on hemodialysis.…”