The role of intraoperative neuromonitoring in microvascular decompression for trigeminal neuralgia: results from a systematic review of the literature

Abstract

The aim of the present study was to conduct a systematic review on the role of intraoperative neuro-monitoring (IONM) in microvascular decompression (MVD) surgery for patients affected by trigeminal neuralgia (TN) specifically regarding its impact on clinical outcomes and whether its use may aid in identifying the site of neurovascular conflict (NVC). We reviewed the literature following PRISMA guidelines to identify and critically assess relevant studies. The review question was formulated according to the PICO framework as follows: "For patients affected by TN undergoing MVD (P), does IONM (I), compared to surgery without neuromonitoring (C), correlate with clinical outcomes? Moreover, can IONM be useful in identifying the NVC (O) site?". The literature search yielded a total of 504 results. After removing duplicates (n = 187), 317 papers were screened. Following title and abstract screening, 307 records were excluded. Ultimately, 10 studies were deemed relevant to the research purpose. IONM plays a significant role in MVD for TN, improving surgical precision, enhancing patient safety, and providing real-time prognostic insights. The included studies have demonstrated its utility in preventing complications and identifying the culprit vessel responsible for NVC during MVD.To the best of our knowledge, this is the first systematic review highlighting the role of IONM in MVD performed for TN and its impact on postoperative clinical outcomes and the intraoperative identification of the NVC. Further prospective studies are needed to standardize IONM protocols and refine its application in MVD, ensuring personalized treatment even in complex cases.

Keywords: Intraoperative neuromonitoring; Microvascular decompression; Neurovascular conflict; Trigeminal neuralgia.