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

Microvascular decompressions (MVDs) are effective open-surgical procedures for trigeminal neuralgia (TN). Intraoperative management of compressive veins may include either venous transposition or coagulation. Although both are generally considered safe, which technique results in optimal postoperative outcomes remains unclear.

To compare postoperative pain and numbness outcomes after an MVD in patients with TN of exclusive venous compression.

We retrospectively reviewed all patients with TN who underwent MVDs at our institution from 2007 to 2020. Patients with TN of pure venous compression were identified using MRI imaging, which was subsequently confirmed intraoperatively. Patient demographics, procedural characteristics, and postoperative pain and numbness scores were recorded and compared. Factors associated with pain recurrence were assessed using survival analyses and multivariate regressions.

We identified 181 patients who presented with TN of pure venous compression. Using a multivariate linear regression, adjusted for age, sex, and presence of multiple sclerosis, use of venous transposition vs coagulation was not significantly associated with the Barrow Neurological Institute pain score at final follow-up, although venous transposition was significantly predictive of a worse postoperative Barrow Neurological Institute numbness score ( P = .003). Using a Kaplan-Meier survival analysis and a multivariate Cox proportional hazards regression, respectively, venous transposition was significantly associated with faster ( P = .01) as well as higher risk for pain recurrence ( P = .01).

The use of venous coagulation during an MVD is associated with better postoperative pain and numbness outcomes. The results of our study may help inform preoperative patient counseling and surgical management for TN cases that involve pure venous compression.