Outcome of Microvascular Decompression in Classical Trigeminal Neuralgia: A Descriptive Study

Background: Classical trigeminal neuralgia (TN) is characterised by recurrent unilateral paroxysmal facial pain associated with neurovascular compression and morphological change of the trigeminal root. Microvascular decompression (MVD) is the preferred surgical treatment in patients who are fit for posterior fossa surgery. This study describes the clinical profile, neurovascular findings, perioperative events and pain outcome up to 24 months after MVD in patients with classical TN. Methods: This descriptive study included Seventy-nine patients with classical TN who underwent MVD in the Department of Neurosurgery, Government Mohan Kumaramangalam Medical College, Salem, between March to August 2024, after Institutional Ethics Committee approval. Pain was graded using the Barrow Neurological Institute (BNI) pain intensity scale before surgery, within 48 hours, and at 1, 3, 6, 12, 18 and 24 months; BNI I–III was considered a favourable outcome. Data were summarised as frequencies, percentages and median (interquartile range). Results: Of the 79 patients, 37 (46.8%) were men and 42 (53.2%) were women. Pain was right-sided in 49 (62.0%), and involvement of the V2 and V3 divisions together was the commonest distribution (31; 39.2%). Preoperatively, 38 patients (48.1%) had BNI IV and 35 (44.3%) had BNI V. MRI showed compression with displacement in 51 (64.6%), compression with atrophy in 20 (25.3%) and contact only in 8 (10.1%). The superior cerebellar artery was the offending vessel in 49 (62.0%), and compression was at the root entry zone in 58 (73.4%). Intraoperative adverse events occurred in 9 patients (11.4%): bradycardia in 6 and bleeding in 3. A favourable outcome (BNI I–III) was recorded in 72 patients (91.1%) within 48 hours and in 70 (88.6%) at 24 months; BNI I was recorded in 68 (86.1%) and 63 (79.7%) patients, respectively. Complications included permanent hearing impairment in 8 (10.1%), stroke or major neurological deficit in 5 (6.3%) and cerebrospinal fluid (CSF) leak in 3 (3.8%). Conclusion: In this series, MVD gave a favourable pain outcome in most patients with classical TN through 24 months of follow-up, although the proportion with complete relief (BNI I) declined from 86.1% at 12 months to 79.7% at 24 months. Larger, multicentre studies with longer follow-up are warranted.