Purely venous compression in trigeminal neuralgia—can we predict the outcome of surgery

Abstract

Purpose Controversies regarding venous compression and trigeminal neuralgia (TN) still exist. The study demonstrates our experience for microvascular decompression (MVD) in TN caused by purely venous compression. The goal was to identify prognostic anatomical or surgical factors that may influence the outcome. Methods Between 2004 and 2020, 49 patients were operated with purely venous compression. Average age was 58.4 years. Mean history of TN was 7.8 years. Microsurgical procedures included transposition or separation of the vein, coagulation, and division. Several features have been analyzed with respect to BNI scores. Results Evaluation on discharge revealed a complete pain relief in 39 (80%), partial improvement in 7 (14%), and no benefit in 3 (6%) patients. Facial hypesthesia was reported by 14 (28.6%) patients. Mean follow-up (FU) was 42.1 months. BNI pain intensity score on FU revealed 71.4% excellent to very good scores (score 1: 32 (65.3%); 2: 3 (6.1%)). BNI facial numbness score 2 could be detected in 13 patients (26.5%) during FU. There was no statistical relationship between immediate pain improvement or BNI pain intensity score on FU with respect to surgical procedure, size of trigeminal cistern, type of venous compression, venous caliber, trigeminal nerve indentation, or neurovascular adherence. BNI facial numbness score was dependent on type of venous compression (p < 0.05). Conclusion We did not find typical anatomical features that could either predict or influence the outcome regarding pain improvement or resolution in any form. Neither classic microvascular decompression (interposition/transposition) nor sacrificing the offending vein made any difference in outcome.

A Case Series of Trigeminal Neuralgia With Pure Venous Compression: Postoperative Outcomes Associated With Intraoperative Venous Transposition Versus Coagulation

“…No significant difference in postoperative BNI pain score at final follow-up, however, was identified, nor did we identify any significant differences in postoperative complications, including cerebrospinal fluid leaks and wound infections. 22 As BNI pain score at final follow-up reflects a single time point, we additionally investigated the time to pain recurrence to better characterize the postoperative timeline for this TN subpopulation. Using Kaplan–Meier survival analysis, patients who received venous transposition experienced recurrence of pain significantly faster than the venous coagulation group ( P = .01), which is supported by the findings from smaller case series in the literature.…”

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

“…[ 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. Based on imaging studies, intracranial venous reflux (IVR) due to the central venous disease (CVD) was suspected as a causative mechanism.…”