Short and long term follow-up of microvascular decompression for the management of trigeminal neuralgia caused by venous compression

Introduction. Classical trigeminal neuralgia is caused by the compression of the trigeminal nerve root and often requires surgical intervention due to the maladaptive intense pain syndrome. Both arteries and veins are considered compressing vessels, however, the role of venous compression in the development of neuralgia remains undefined. The aim of the study was to investigate the effectiveness of microvascular decompression in the treatment of trigeminal neuralgia caused by venous compression, considering the use of various surgical tactics. Material and methods. A retrospective analysis of surgical outcomes in 70 patients who underwent microvascular decompression for trigeminal neuralgia at the Federal Neurosurgical Center (Novosibirsk, Russia) between 2017 and 2021 was conducted. The study included 46 women and 24 men aged 23–82 years with unilateral facial pain. Brain MRI was performed preoperatively to evaluate neuroimaging picture and to clarify the relationships between the trigeminal nerve root and adjacent vessels. The surgical results were assessed during follow-up using the Barrow Neurological Institution (BNI) scale. Results. The study showed that venous neurovascular compression is frequently found in trigeminal neuralgia patients undergoing microvascular decompression in 26.9 % of cases. Various operative strategies were used when venous compression was detected, with high short-term success rates and lower recurrence rates. Long-term monitoring indicated pain relief in 71.4 % of cases (BNI I–II) and pain recurrence in 28.6 % of cases (BNI III, IV, V). Conclusion. This study highlights the effectiveness of microvascular decompression in treating classical trigeminal nerve neuralgia caused by venous compression and emphasizes the importance of individual surgical tactics based on the characteristics of the adjacent veins to achieve optimal results.

1. Zakrzewska J.M., Linskey M.E. Trigeminal neuralgia. BMJ. 2015;350:h1238. doi: 10.1136/bmj.h1238

2. Cruccu G., Finnerup N.B., Jensen T.S., Scholz J., Sindou M., Svensson P., Treede R.D., Zakrzewska J.M., Nurmikko T. Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology. 2016;87(2):220–228. doi: 10.1212/WNL.0000000000002840

3. Zakrzewska J.M., Linskey M.E. Trigeminal neuralgia. BMJ. 2014;348:g474. doi: 10.1136/bmj.g474

4. van Kleef M., van Genderen W.E., Narouze S., Nurmikko T.J., van Zundert J., Geurts J.W, Mekhail N.; World Institute of Medicine. 1. Trigeminal neuralgia. Pain. Pract. 2009;9(4):252–259. doi: 10.1111/j.1533-2500.2009.00298.x

5. Woolfall P., Coulthard A. Pictorial review: Trigeminal nerve: anatomy and pathology. Br. J. Radiol. 2001;74(881):458–467. doi: 10.1259/bjr.74.881.740458

6. Baldauf J., Refaee E.E., Marx S., Matthes M., Fleck S., Schroeder H.W.S. Purely venous compression in trigeminal neuralgia-can we predict the outcome of surgery. Acta Neurochir. (Wien). 2022;164(6):1567–1573. doi: 10.1007/s00701-022-05176-z

7. Brînzeu A., Drogba L., Sindou M. Reliability of MRI for predicting characteristics of neurovascular conflicts in trigeminal neuralgia: implications for surgical decision making. J. Neurosurg. 2018;130(2):611–621. doi: 10.3171/2017.8.JNS171222

8. Zhao Y., Chen J., Jiang R., Xu X., Lin L., Xue Y., Duan Q. MRI features of responsible contacts in vascular compressive trigeminal neuralgia and prediction modeling. Acta Radiol. 2022;63(1):100–109. doi: 10.1177/0284185120983971

9. Hong W., Zheng X., Wu Z., Li X., Wang X., Li Y., Zhang W., Zhong J., Hua X., Li S. Clinical features and surgical treatment of trigeminal neuralgia caused solely by venous compression. Acta Neurochir. (Wien). 2011;153(5):1037–1042. doi: 10.1007/s00701-011-0957-x

10. Leal P.R., Hermier M., Froment J.C., Souza M.A., Cristino-Filho G., Sindou M. Preoperative demonstration of the neurovascular compression characteristics with special emphasis on the degree of compression, using high-resolution magnetic resonance imaging: a prospective study, with comparison to surgical findings, in 100 consecutive patients who underwent microvascular decompression for trigeminal neuralgia. Acta Neurochir. (Wien). 2010;152(5):817–825. doi: 10.1007/s00701-009-0588-7

11. Inoue T., Hirai H., Shima A., Suzuki F., Fukushima T., Matsuda M. Diagnosis and management for trigeminal neuralgia caused solely by venous compression. Acta Neurochir. (Wien). 2017;159(4):681–688. doi: 10.1007/s00701-017-3085-4

12. Montano N., Conforti G., di Bonaventura R., Meglio M., Fernandez E., Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther. Clin. Risk Manag. 2015;11:289–299. doi: 10.2147/TCRM.S37592

13. Burchiel K.J. trigeminal neuralgia: new evidence for origins and surgical treatment. Neurosurgery. 2016;63 Suppl 1:52–55. doi: 10.1227/NEU.0000000000001276

14. Strauss C., Naraghi R., Bischoff B., Huk W.J., Romstöck J. Contralateral hearing loss as an effect of venous congestion at the ipsilateral inferior colliculus after microvascular decompression: report of a case. J. Neurol. Neurosurg. Psychiatry. 2000;69(5):679–682. doi: 10.1136/jnnp.69.5.679

15. Koerbel A., Wolf S.A., Kiss A. Peduncular hallucinosis after sacrifice of veins of the petrosal venous complex for trigeminal neuralgia. Acta Neurochir. (Wien). 2007;149(8):831–832; discussion 832–833. doi: 10.1007/s00701-007-1181-6

16. Masuoka J., Matsushima T., Hikita T., Inoue E. Cerebellar swelling after sacrifice of the superior petrosal vein during microvascular decompression for trigeminal neuralgia. J. Clin. Neurosci. 2009;16(10):1342–1344. doi: 10.1016/j.jocn.2008.12.024

17. Lee S.H., Levy E.I., Scarrow A.M., Kassam A., Jannetta P.J. Recurrent trigeminal neuralgia attributable to veins after microvascular decompression. Neurosurgery. 2000;46(2):356–361; discussion 361–362. doi: 10.1097/00006123-200002000-00019

18. Zhong J., Li S.T., Xu S.Q., Wan L., Wang X. Management of petrosal veins during microvascular decompression for trigeminal neuralgia. Neurol. Res. 2008;30(7):697–700. doi: 10.1179/174313208X289624

19. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. doi: 10.1177/0333102417738202

20. Rogers C.L., Shetter A.G., Fiedler J.A., Smith K.A., Han P.P., Speiser B.L. Gamma knife radiosurgery for trigeminal neuralgia: the initial experience of The Barrow Neurological Institute. Int. J. Radiat. Oncol. Biol. Phys. 2000;47(4):1013–1019. doi: 10.1016/s0360-3016(00)00513-7

21. Dumot C., Sindou M. Trigeminal neuralgia due to neurovascular conflicts from venous origin: an anatomical-surgical study (consecutive series of 124 operated cases). Acta Neurochir. (Wien). 2015;157(3):455–466. doi: 10.1007/s00701-014-2330-3

22. Fayed Z.Y., Afify H. Long-term follow-up of microvascular decompression for management of trigeminal neuralgia. The Egyptian Journal of Neurosurgery. 2022;37:30. doi: 10.1186/s41984-022-00171-z

23. Wu M., Fu X., Ji Y., Ding W., Deng D., Wang Y., Jiang X., Niu C. Microvascular decompression for classical trigeminal neuralgia caused by venous compression: novel anatomic classifications and surgical strategy. World Neurosurg. 2018;113:e707–e713. doi: 10.1016/j.wneu.2018.02.130

24. Zhao Y., Zhang X., Yao J., Li H., Jiang Y. Microvascular decompression for trigeminal neuralgia due to venous compression alone. J. Craniofac. Surg. 2018;29(1):178–181. doi: 10.1097/SCS.0000000000004174

25. Wang W., Yu F., Kwok S.C., Wang Y., Yin J. Microvascular decompression for trigeminal neuralgia caused by venous offending on the ventral side of the root entrance/exit zone: classification and management strategy. Front. Neurol. 2022;13:864061. doi: 10.3389/fneur.2022.864061

26. Wei Y., Pu C., Li N., Cai Y., Shang H., Zhao W. Long-term therapeutic effect of microvascular decompression for trigeminal neuralgia: Kaplan-Meier analysis in a consecutive series of 425 patients. Turk. Neurosurg. 2018; 28(1):88–93. doi: 10.5137/1019-5149.JTN.18322-16.1

27. Herta J., Schmied T., Loidl T.B., Wang W.T., Marik W., Winter F., Tomschik M., Ferraz-Leite H., Rössler K., Dorfer C. Microvascular decompression in trigeminal neuralgia: predictors of pain relief, complication avoidance, and lessons learned. Acta Neurochir. (Wien). 2021;163(12):3321–3336. doi: 10.1007/s00701-021-05028-2

28. Noorani I., Lodge A., Durnford A., Vajramani G., Sparrow O. Comparison of first-time microvascular decompression with percutaneous surgery for trigeminal neuralgia: long-term outcomes and prognostic factors. Acta Neurochir. (Wien). 2021;163(6):1623–1634. doi: 10.1007/s00701-021-04793-4