Outcomes of Microvascular Decompression for Young-Onset Trigeminal Neuralgia

BACKGROUND AND OBJECTIVES: The surgical treatment of trigeminal neuralgia (TN) in young patients is challenging, and there is mixed evidence regarding the efficacy of microvascular decompression (MVD) in this patient population. We examined long-term clinical outcomes after MVD in patients with pediatric and young-onset TN. METHODS: Between 2007 and 2023, 22 patients with classical TN symptom onset before age 30 years underwent MVD for TN at or before age 30 years. A retrospective chart review was used to gather information on clinical characteristics, imaging, and long-term outcomes in these patients. RESULTS: Twenty-two patients-15 women (68.2%) and 7 men (31.8%) with a median age at surgery of 26.7 years (range 20-30 years)-underwent MVD for TN: 17 patients experienced purely paroxysmal pain (PPP) (77.3%) and 5 patients experienced concomitant continuous pain (CCP) (22.7%). Nine of 22 patients (40.9%) were immediately pain free without medication following MVD, while 14 of 22 (63.6%) patients were pain free without medication at a median follow-up of 9.38 years, all 14 of whom experienced PPP. Lesser occipital neuralgia occurred in 2 patients (9.1%). Five patients (22.7%) required subsequent procedures for TN during the follow-up period. The absence of CCP was significantly associated with pain freedom without medication at the final follow-up (P = .0021). CONCLUSION: MVD is safe and effective for the treatment of TN in patients aged 30 years or younger who exhibit symptoms consistent with classical TN. However, long-term pain relief may be less likely in young-onset TN patients with CCP compared with those who have PPP.