Effects of diagnosed depression on postoperative outcomes after microvascular decompression for patients with...

Depression is believed to be prevalent in patients with trigeminal neuralgia (TN); however, its effect on postoperative outcomes in patients undergoing microvascular decompression (MVD) is not well understood. This study aims to characterize the association between a history of diagnosed depression and postoperative outcomes in patients undergoing MVD for TN.

The medical records for 1007 patients with TN who underwent MVD at our institution from 2007 to 2023 were reviewed. Demographic characteristics, comorbid conditions, clinical TN characteristics, pain recurrence, and pre-operative and post-operative Modified Barrow Neurological Institute (BNI) pain and numbness scores were compared between groups. Differences in pain outcomes were evaluated via multivariate ordinal regression, Kaplan-Meier analysis, and Cox proportional hazards analysis.

181 (18.0 %) of patients had diagnosed depression. Patients with depression were younger (p = 0.005), more often female (p < 0.001), and more likely to be White (p = 0.012). Type 2 TN was more common in those with depression (p < 0.001). Depression was independently associated with higher pain at last follow-up (p = 0.009), less time to recurrent pain on Kaplan-Meier analysis (p = 0.0063), and was predictive of recurrent pain on Cox proportional hazards regression (p = 0.048).

A diagnosis of depression in patients undergoing MVD for TN is associated with greater postoperative pain and increased risk of pain recurrence, suggesting that depression is not only highly prevalent in patients with TN, but also may contribute to worse outcomes. These findings emphasize the need for adequate psychiatric screening before MVD and have implications for the preoperative counseling and management of this population.