Surgical Outcomes Following Distal Nerve Decompression in Patients With Trigeminal Neuralgia

Patients with headache disorders may present with compression of distal trigeminal nerve branches as well as other head and neck nerve branches such as the occipital nerves. In addition, a coexisting diagnosis of trigeminal neuralgia of proximal origin may be present. This overlap in diagnoses complicates treatment. Therefore, this study aimed to investigate the therapeutic effects of distal nerve decompression surgery in patients with coexisting trigeminal neuralgia from a proximal origin.

The charts of 1112 patients who underwent screening for nerve decompression surgery were retrospectively reviewed. Patients with trigeminal neuralgia who underwent nerve decompression surgery were included. Data regarding preoperative and postoperative pain characteristics were collected.

Seventeen (1.5%) patients met the inclusion criteria and underwent nerve decompression. Fifteen patients (56%) underwent occipital decompression (13 greater occipital nerve decompressions, and 10 lesser occipital nerve decompressions), 5 patients (19%) underwent frontal decompression (supraorbital nerve/supratrochlear nerve decompression), and 6 patients (22%) underwent temporal decompression (4 zygomaticotemporal decompressions and 2 auriculotemporal nerve decompressions). Among the patients who underwent occipital decompression, 11 (73%) patients reported ≥80% pain relief, 1 (6.7%) patient reported ≥50% pain relief, and 3 (20%) patients reported ≤20% pain relief. For frontal and/or temporal decompression, only 2 (28%) patients achieved substantial pain relief (100% and 50%), whereas 5 (71%) patients experienced ≤20% pain relief.

Our results demonstrate that occipital nerve decompression is an effective treatment for alleviating occipital neuralgia in individuals with coexisting proximal trigeminal neuralgia. However, the outcomes of frontal and temporal decompression were less favorable.