Hipoestesia postoperatoria temprana tras descompresión microvascular para el trigémino como predictor de éxito a...

Microvascular decompression (MVD) is an effective treatment for trigeminal neuralgia (TGN), but anatomical/clinical predictors of long-term outcomes are incompletely defined, and many studies emphasize only immediate complications. This study investigates long-term outcomes after MVD for TGN and predictors of postoperative pain relief and recurrence.

132 MVDs performed for TGN in 124 patients (February 2012-November 2021) were retrospectively analysed. Demographics, prior therapies, preoperative MRI, intraoperative findings, and postoperative course were recorded. Outcomes included Barrow Neurological Institute (BNI) pain scores, recurrence, and complications over a median 94-month follow-up.

Immediate pain improvement occurred in 98% of procedures; 90-day and 1-year mortality were 0%. Early postoperative trigeminal hypoesthesia occurred in 32% and predicted long-term complete pain relief (p=0.0019). Among hypoesthesia cases, severity was mild 69%, moderate 19%, severe 4.8%, and anesthesia dolorosa 7.1%; median time to resolution was 6 months (IQR (interquartile range) 4-10), with 78% resolving within 12 months; corneal anesthesia occurred in 7.1%. Hypoesthesia was not associated with intraoperative venous (p=0.671) or arterial (p=0.222) contact. Overall recurrence was 21% (median 18 months); fibromyalgia was associated with recurrence (p=0.00054). Absence of neurovascular contact on preoperative MRI did not predict recurrence (p=0.255). Intraoperative vessel contact was associated with lower recurrence than no contact (p=0.012), while venous-only contact had the highest recurrence (46%) (p=0.056).

Early post-MVD trigeminal hypoesthesia is a simple bedside marker predicting superior long-term pain relief. Preoperative MRI vascular contact is not required for favorable outcome, whereas isolated venous conflict may increase recurrence risk.