Early postoperative hypoesthesia after trigeminal MVD is a predictor of long-term success: a long-term cohort study

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. 1 32 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.