Optimizing microvascular decompression for venous compression in trigeminal neuralgia: clinical outcomes and technical considerations

OBJECTIVES: Venous compression is an underrecognized cause of trigeminal neuralgia (TN) and remains controversial due to its subtle imaging manifestations, variable anatomy, and uncertain optimal surgical management. This study aimed to clarify the anatomical spectrum of venous offenders, evaluate surgical outcomes, and explore the role of adjunctive trigeminal nerve combing (NC) in selected cases. METHODS: = 20). Preoperative evaluation, operative videos, complications, and follow-up status were reviewed. Follow-up averaged 5 years. RESULTS: > 0.05). Five patients with low-tension pure venous compression underwent adjunctive NC, achieving satisfactory long-term relief. Complications were mild and transient; no venous infarction occurred. CONCLUSION: Venous compression constitutes a distinct and surgically manageable subtype of TN. When combined with full-length exposure from the REZ to Meckel's cave, tailored approaches - including selective venous transposition or division and NC for low-tension adhesions - achieve durable pain control with minimal morbidity.