Outcomes After Microvascular Decompression for Sole Arterial Versus Venous Compression in Trigeminal Neuralgia

Dural arteriovenous fistula presenting as trigeminal neuralgia: Case report and literature review

“…Therefore, we believe that the trigeminal nerve remains compressed because of irreversible venous dilatation changes in some cases [ 8 , 22 ]. Xu et al reviewed 642 cases and found that patients with preoperative sole venous compression of the trigeminal nerve had worse pre- and postoperative pain scores, as well as higher recurrence rates, compared to those with sole arterial compression [ 26 ]. Similar findings have been reported in other cohort studies [ 3 , 27 ].…”

“…Similar findings have been reported in other cohort studies [ 3 , 27 ]. One potential explanation is that the non-pulsatile blood flow pattern and chronic, constant compressive force exerted by dilated veins may elicit a more pronounced neuropathic pain response versus the intermittent pulsations from arterial loops [ 26 ]. Therefore, in cases refractory to embolization, radiosurgery, or MVD, the pulsatile nature of the compressive force as well as differential biomechanical properties between muscular arterial versus thin-walled venous structures may play a key role in symptomatology of TN.…”

The outcomes of microvascular decompression for primary trigeminal neuralgia: insights from a single-center experience and technical advancements

“…In cases of venous compression of the trigeminal nerve, the rate of recurrence is higher compared to arterial compression. According to Sumil K Nair's findings, patients experiencing TN due to venous compression generally present more severe pain outcomes following MVD, in contrast to patients solely affected by arterial compression ( 33 ). In our population study, cases with fair and poor outcomes could potentially be related to venous compression.…”

Commentary: Neurovascular Compression in Patients With Trigeminal Neuralgia May Be Associated With Worse Outcomes After Primary Percutaneous Rhizotomy

“…However, the temporary effect of percutaneous ablations was not the primary topic of investigation by the authors of this study 1 ; the superiority of MVD compared with percutaneous destructions and radiosurgery has been shown in the past in many individual series and meta-analyses. 2-5 Instead, the authors focused on the difference in pain-free survival after percutaneous rhizotomy between those with radiographically documented vascular compression of the trigeminal nerve and those without such compression on preoperative MRI studies.…”

“…Finally, I feel that although I—like many neurosurgeons—continue to describe patients with TN as those with or without radiographic vascular compression, 12,13 the neurological community seems to have moved on in differentiating primary TN into 2 distinct forms: the classical TN that is associated with vascular compression of the nerve root and idiopathic TN that occurs without such compression. 14-16 Based on the findings of this study, 1 it appears that primary percutaneous rhizotomy may be recommended for patients with idiopathic TN but not so much for those with classic TN, for whom MVD should be considered the preferred surgical approach. If that turns out to be true, we may have to consider updating our current facial pain treatment algorithm that was published more than 15 years ago but remains useful in our daily practice.…”