The clinical outcomes of microvascular decompression for neurovascular compression syndromes: A single surgeon approach and insights from an Indonesian tertiary level single neurosurgical center

Neurovascular compression syndrome (NCS) is a disorder caused by the compression of cranial nerves at the root entry zone (REZ), manifesting primarily as trigeminal neuralgia (TN) and hemifacial spasm (HFS). Despite the established efficacy of microvascular decompression (MVD), the application of this procedure in Indonesia is still under-explored, with limited data on its outcomes in local populations. To evaluate the outcomes of patients with primary TN and HFS who underwent MVD and to present our experience with a single-surgeon approach. This study retrospectively analyzed 32 patients who underwent MVD for TN and HFS between 2021 and 2025. We evaluated their clinical and operative findings, and outcomes. Among the 25 patients with TN, MVD resulted in good post-operative pain control (BNI grade I–II) in 88% of TN cases and favorable numbness outcomes in 92%. Severe neurovascular conflict (NVC) grades were significantly associated with improved pain (p = 0.038) and numbness (p = 0.003). The presence of basilar artery or complex vascular involvement showed less favorable outcomes (pain: p = 0.101; numbness: p < 0.001). For 7 patients with HFS, age and pre-operative SMC grades were significantly associated with good outcomes (age: p = 0.003; SMC: p = 0.008). MVD under single-surgeon protocol delivers high efficacy and safety for TN and HFS with low complication rates and NVC severity contributes significantly in predicting success of this procedure.