Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun;164(6):1567-1573.
doi: 10.1007/s00701-022-05176-z. Epub 2022 Mar 11.

Purely venous compression in trigeminal neuralgia-can we predict the outcome of surgery

Jörg Baldauf  1 , Ehab El Refaee  2 , Sascha Marx  2 , Marc Matthes  2 , Steffen Fleck  2 , Henry W S Schroeder  2
Affiliations

Purely venous compression in trigeminal neuralgia-can we predict the outcome of surgery

Jörg Baldauf et al. Acta Neurochir (Wien). 2022 Jun.

Abstract

Purpose: Controversies regarding venous compression and trigeminal neuralgia (TN) still exist. The study demonstrates our experience for microvascular decompression (MVD) in TN caused by purely venous compression. The goal was to identify prognostic anatomical or surgical factors that may influence the outcome.

Methods: Between 2004 and 2020, 49 patients were operated with purely venous compression. Average age was 58.4 years. Mean history of TN was 7.8 years. Microsurgical procedures included transposition or separation of the vein, coagulation, and division. Several features have been analyzed with respect to BNI scores.

Results: Evaluation on discharge revealed a complete pain relief in 39 (80%), partial improvement in 7 (14%), and no benefit in 3 (6%) patients. Facial hypesthesia was reported by 14 (28.6%) patients. Mean follow-up (FU) was 42.1 months. BNI pain intensity score on FU revealed 71.4% excellent to very good scores (score 1: 32 (65.3%); 2: 3 (6.1%)). BNI facial numbness score 2 could be detected in 13 patients (26.5%) during FU. There was no statistical relationship between immediate pain improvement or BNI pain intensity score on FU with respect to surgical procedure, size of trigeminal cistern, type of venous compression, venous caliber, trigeminal nerve indentation, or neurovascular adherence. BNI facial numbness score was dependent on type of venous compression (p < 0.05).

Conclusion: We did not find typical anatomical features that could either predict or influence the outcome regarding pain improvement or resolution in any form. Neither classic microvascular decompression (interposition/transposition) nor sacrificing the offending vein made any difference in outcome.

Keywords: Microvascular decompression; Trigeminal neuralgia; Vascular compression syndromes; Venous compression.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Typical venous compression (right side) resolved by microvascular decompression. A) Endoscopic view: superior petrosal vein (SPV) is separated from the trigeminal nerve (TN). Indentation to the nerve is impressively shown (white arrows). B) Microscopic view: Teflon sponge (asterix) is placed between TN and SPV. Tiny transverse crossing venous branches have been coagulated and divided. C) Endoscopic view after decompression
Fig. 2
Fig. 2
Transverse petrosal vein (TPV) crossing the trigeminal nerve (TN) close to Meckel’s cave (endoscopic images A + B). C) TN after coagulation and division of the TPV
See this image and copyright information in PMC

References

    1. Barker FG, 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334:1077–1083. doi: 10.1056/NEJM199604253341701. - DOI - PubMed
    1. Dumot C, Brinzeu A, Berthiller J, Sindou M. Trigeminal neuralgia due to venous neurovascular conflicts: outcome after microvascular decompression in a series of 55 consecutive patients. Acta Neurochir (Wien) 2017;159:237–249. doi: 10.1007/s00701-016-2994-y. - DOI - PubMed
    1. Dumot C, Sindou M. Trigeminal neuralgia due to neurovascular conflicts from venous origin: an anatomical-surgical study (consecutive series of 124 operated cases) Acta Neurochir (Wien) 2015;157:455–466. doi: 10.1007/s00701-014-2330-3. - DOI - PubMed
    1. Feng B, Zheng X, Wang X, Wang X, Ying T, Li S. Management of different kinds of veins during microvascular decompression for trigeminal neuralgia: technique notes. Neurol Res. 2015;37:1090–1095. doi: 10.1080/01616412.2015.1115588. - DOI - PubMed
    1. Han PP, Shetter AG, Smith KA, Fiedler JA, Rogers CL, Speiser B, Feiz-Erfan I. Gamma Knife Radiosurgery for Trigeminal Neuralgia. Stereotact Funct Neurosurg. 1999;73:131–133. doi: 10.1159/000029771. - DOI - PubMed

Publication types