Awake Microvascular Decompression for Trigeminal Neuralgia: Concept and Initial Results

Area of Science:

• Neurosurgery
• Anesthesiology
• Neurology

Background:

• Microvascular decompression (MVD) is a surgical treatment for trigeminal neuralgia (TN).
• General endotracheal anesthesia (GEA) may pose risks for patients with comorbidities.
• Awake anesthesia protocols offer an alternative for MVD.

Purpose of the Study:

• To evaluate awake MVD for TN.
• To determine if intraoperative pain evaluation can identify insufficient trigeminal nerve decompression.
• To assess if awake MVD can improve surgical outcomes and expand MVD indications.

Main Methods:

• Prospective study of 10 adult patients undergoing MVD for TN.
• Procedure performed under an awake anesthesia protocol.
• Postoperative TN pain assessed using the Barrow Neurological Institute (BNI) Pain Severity Scale.

Main Results:

• All 10 patients tolerated awake MVD well, avoiding GEA.
• Nine patients achieved successful outcomes (BNI scores I or II).
• Intraoperative awake testing identified two cases of insufficient decompression, which were corrected, resolving pain.

Conclusions:

• Intraoperative awake testing during MVD can enhance surgical success rates.
• This method effectively identifies and addresses inadequate cranial nerve V decompression.
• Awake MVD is a viable option for TN patients, potentially broadening treatment accessibility.