Trigeminal Microvascular Decompression for Medically Refractory Short-Lasting Unilateral Neuralgiform Headache...

Area of Science:

• Neurosurgery
• Neurology
• Pain Management

Background:

• Short-lasting Unilateral Neuralgiform Headache Attacks (SUNHA) present a significant challenge in medical management.
• Medically refractory SUNHA cases often require advanced treatment strategies.
• Trigeminal neurovascular conflict (NVC) is implicated in the pathophysiology of SUNHA.

Purpose of the Study:

• To evaluate the sustained efficacy and safety of trigeminal microvascular decompression (MVD) for SUNHA.
• To assess MVD outcomes in patients with medically refractory SUNHA and ipsilateral trigeminal NVC.
• To determine long-term pain relief and complication rates following MVD.

Main Methods:

• Retrospective analysis of prospectively collected data from SUNHA patients undergoing MVD.
• Pre-operative MRI with specific trigeminal sequences to identify NVC.
• Barrow Neurological Institute (BNI) pain intensity score used for response assessment.
• Follow-up assessment using BNI scores to determine sustained response.

Main Results:

• 18 medically refractory SUNHA patients underwent trigeminal MVD.
• Trigeminal NVC with morphological changes identified in 72.2% of patients.
• 89.0% of patients achieved a responder status (BNI 1-2) post-operatively.
• Sustained response (BNI 1-2) observed in 72.2% of patients at a mean follow-up of 54.3 months.
• Low complication rates, including transient dizziness and incision site pain.

Conclusions:

• Trigeminal MVD is a safe and effective treatment for medically refractory SUNHA.
• Surgical intervention is recommended for SUNHA patients with MRI-confirmed trigeminal NVC.
• MVD provides sustained pain relief for a significant majority of suitable SUNHA patients.