Outcomes of microvascular decompression for trigeminal neuralgia: a retrospective analysis from a Mexican high-specialty center

Abstract

Background Trigeminal neuralgia (TN) is a severe craniofacial pain disorder that significantly impacts patient quality of life. Microvascular decompression (MVD) is the sole surgical technique directly addressing the underlying neurovascular conflict, offering durable pain relief. However, data from Latin American populations remain limited. Objective To evaluate pain improvement, recurrence, and complications in patients with classic TN undergoing MVD at a Mexican high-specialty center. Methods We retrospectively analyzed 61 consecutive classic TN patients who underwent MVD (2010-2023). Their clinical records provided demographic data, pain characteristics, Barrow Neurological Institute Pain Scale (BNI-PS) scores, intraoperative findings, and long-term outcomes. The statistical analyses were performed through the McNemar and Cochran Q tests for longitudinal changes. Results The cohort was predominantly composed of women (80.3\%; median age: 59 years). Preoperatively, most reported severe pain (BNI-PS score: IV-V). After MVD, 57.4\% achieved complete pain relief (BNI-PS score: I) and 13.1\% had occasional pain not requiring medication (BNI-PS score: II) at the long-term follow-up. Neurovascular compression was identified in 96.7\% of the cases, most frequently by the superior cerebellar artery (49.2\%). The overall recurrence rate was of 14.8\%, with 8.2\% requiring reoperation. Early complications included transient cerebellar syndrome (8.2\%) and facial hypoesthesia (11.5\%); 1 case of mortality occurred due to hypertensive hemorrhage. Conclusion Microvascular decompression is a safe, effective, and durable treatment for classic TN, achieving long-term pain relief in more than 70\% of the patients. The present study offers valuable clinical data from a Mexican cohort, reinforcing the efficacy and reproducibility of the procedure in diverse neurosurgical settings.