Microvascular decompression for vertebrobasilar dolichoectasia-related primary trigeminal neuralgia: surgical...

Objectives To investigate the surgical strategies, technical aspects, and clinical outcomes of microvascular decompression (MVD) in treating primary trigeminal neuralgia (PTN) associated with vertebrobasilar dolichoectasia (VBD). Methods A retrospective analysis was conducted on 34 consecutive VBD-related PTN patients treated by a single neurosurgeon at China-Japan Friendship Hospital from January 2020 to April 2025. VBD compression patterns were classified into two types: Type I: Imaging showing significant brainstem deformation and obliteration of the arachnoid space by VBD (n = 16, 47.1%). Type II: Imaging confirming VBD with minimal or no brainstem deformation and preserved arachnoid space (n = 18, 52.9%). Type-specific MVD techniques were applied: a four-step approach for Type I and a three-step approach for Type II. Outcomes were assessed using the Barrow Neurological Institute Pain Intensity Scale (BNI) during follow-up (range: 2-64 months). Results Among 1,214 PTN patients treated during the study period, 34 (2.8%) had VBD-related PTN. Preoperative BNI grades: Grade V in 8 patients (23.5%), Grade IV in 26 patients (76.5%). Comorbid cranial neuropathies were present in 17.6% (6/34) of patients. Postoperative outcomes: BNI Grade I in 91.2% (31/34), BNI Grade II in 8.9% (3/34). The overall success rate (BNI ≤ II) was 100%. Conclusion VBD-related PTN is a rare condition characterized by severe refractory pain. Tailored MVD strategies, based on VBD compression morphology (Type I vs. Type II), provide a safe and effective surgical approach, resulting in excellent pain relief.