Magnetic resonance imaging-guided surgical strategies for treating trigeminal neuralgia without vascular compression

Objective

To describe the surgical strategy, curative effect and postoperative complications of trigeminal neuralgia (TN) without vascular compression using head magnetic resonance imaging (MRI).

Methods

We retrospectively enrolled 184 patients with TN who were admitted to the Department of Neurosurgery of Zhoukou Central Hospital from January 2018 to March 2021 and had complete clinical data. Preoperative MRI reveled that 35 patients (19.0%) had no vascular compression. Among them, 16 (45.7%) had simple venous compression during surgery, 9 (25.7%) had venous compression and arachnoid adhesion during surgery, 5 (14.3%) had arachnoid adhesion during surgery, 3 (8.6%) had no venous compression or arachnoid adhesion during surgery, and 2 (5.7%) had simple artery compression during surgery. During the operation, the corresponding surgical strategies for the various types of venous compression were developed. Postoperative efficacy was assessed using the Barrow Neurological Institute pain intensity and facial numbness scores.

Results

According to the four types of compression identified during the operation, which did not reveal obvious vascular compression on preoperative head MRI, appropriate decompression methods were found to effectively relieve or eliminate pain (97.1%), and the postoperative effect was relatively satisfactory. There was no recurrence after 1–2 years of follow-up. After operation, two patients (5.7%) experienced occasional pain, one patient (2.9%) reported minor pain, and two patients (5.7%) reported numbness on the affected side of the face. Furthermore, one patient had aseptic meningitis (2.9%) and one patient (2.9%) had transient tinnitus or hearing loss on the affected side.

Conclusion

For patients with (TN) without vascular compression on head MRI prior to surgery, different surgical strategies can be implemented based on microvascular decompression and adequate trigeminal nerve decompression findings. Our results showed that these strategies could achieve satisfactory postoperative results without increasing postoperative complications.