Surgical outcomes of glycerol rhizolysis in trigeminal neuralgia defined by neurovascular compression

INTRODUCTION: Trigeminal neuralgia (TGN) is often treated with glycerol rhizolysis (GR) when medically refractory, yet the influence of neurovascular compression (NVC) on postoperative outcomes and recurrence remains unclear. We aimed to identify the role of NVC on outcomes following GR. METHODS: We conducted a retrospective cohort study of adults with medically refractory classical or idiopathic TGN who underwent glycerol rhizolysis between 2014 and 2024. Demographic, clinical, radiological, and surgical variables, including NVC type and severity, were collected. Postoperative pain was assessed using the Barrow Neurological Institute (BNI) scale at discharge and 1 year, with recurrence evaluated across longitudinal follow-up. Multiple linear and Cox proportional hazard regressions identified predictors of postoperative BNI and recurrence, with group comparisons performed using t-tests, ANOVA, and Log-rank tests. RESULTS: < 0.05). Increasing age, displaced neurovascular compression, arterial compression, longer symptom duration, and higher preoperative BNI independently predicted worse postoperative BNI scores. Male sex, displaced compression, absence of ipsilateral compression, and higher preoperative BNI were associated with increased risk of recurrence. CONCLUSION: Neurovascular compression type and severity significantly impact postoperative pain and recurrence after glycerol rhizolysis. Incorporating NVC characteristics into preoperative planning may improve patient selection and treatment outcomes.