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Comparative Study
. 2025 Aug 21;167(1):225.
doi: 10.1007/s00701-025-06651-z.

Efficacy analysis of microvascular decompression and percutaneous balloon compression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia: a retrospective cohort study

Ziwei Gao #  1   2 , Renfu Liu #  1   2 , Peng Lin #  3 , Xiangtao Zhang  1   2 , Yawen Xu  1   2 , Yuanxiang Lin  4   5   6 , Peisen Yao  7   8   9
Affiliations
Comparative Study

Efficacy analysis of microvascular decompression and percutaneous balloon compression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia: a retrospective cohort study

Ziwei Gao et al. Acta Neurochir (Wien). .

Abstract

Background: Trigeminal neuralgia secondary to vertebrobasilar dolichoectasia (VBD-TN) poses a significant challenge in the surgical management of trigeminal neuralgia. This study aimed to evaluate and compare the therapeutic efficacy of microvascular decompression (MVD) and percutaneous balloon compression (PBC) in patients with VBD-TN.

Methods: We conducted a retrospective cohort analysis of consecutive VBD-TN patients treated at a tertiary hospital in China between September 2013 and August 2022. Participants were stratified by the intervention (MVD vs PBC), with systematic evaluation of postoperative pain control efficacy and complication rates.

Results: This study enrolled 107 patients with VBD-TN, with a mean age of 64.8 ± 10.0 years and a mean follow-up duration of 3.9 ± 1.9 years. The cohort comprised 64 patients undergoing MVD and 43 receiving PBC. Both groups achieved excellent initial pain control (The Barrow Neurological Institute scoring system (BNI) pain score I or II). The recurrence (BNI Ⅲ, Ⅳ, Ⅴ) rates were 12.5% (8/64) in the MVD group versus 20.9% (9/43) in the PBC group (p = 0.242) at the last follow-up, showing no statistically significant difference. Early postoperative assessment revealed significantly higher incidences of trigeminal dysfunction including facial numbness, dry eye symptoms, and masticatory muscle weakness in the PBC group compared to the MVD group (p < 0.05 for all). Conversely, the MVD group demonstrated more diverse complications, with craniotomy-related adverse events including intracranial infection (4.7%), cerebrospinal fluid leakage (3.1%), and incision infection (3.1%), while cranial nerve complications comprised diplopia (3.1%), facial palsy (1.6%), hearing loss (7.8%), and tinnitus (9.4%). At the final follow-up, the PBC group exhibited significantly higher BNI numbness scores than the MVD group (p = 0.001). The PBC group showed advantages in healthcare utilization metrics, with significantly shorter postoperative hospital stays and lower hospitalization costs compared to the MVD group (p < 0.001).

Conclusions: Both MVD and PBC are safe and effective therapeutic options for VBD-TN. MVD is associated with higher hospitalization costs, prolonged hospital stays, and a greater incidence of cranial nerve complications, though most of these complications are treatable. The main disadvantage of PBC lies in the long-term facial numbness.

Keywords: Efficacy; Microvascular decompression; Percutaneous balloon compression; Trigeminal neuralgia; Vertebrobasilar dolichoectasia.

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Conflict of interest statement

Declarations. Ethical approval: This study was conducted in accordance with the Helsinki Declaration and received approval from the ethics committee of our institution (IEC-FOM-013–2.0). Consent to participate: Due to the retrospective nature of this study, patients’ informed consent was waived and the study is exempt from the requirement for informed consent. Competing interests: The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
MRI shows neurovascular compression. (a) (b) Axial and sagittal views of 3D-SPACE trigeminal nerve hydrography. Red arrows: vertebral artery; yellow arrows: trigeminal nerve
Fig. 2
Fig. 2
Flowchart of surgical selection process
Fig. 3
Fig. 3
Kaplan–Meier analysis of the effective rate of pain control in the MVD group and the PBC group. BNI The Barrow Neurological Institute scoring system
See this image and copyright information in PMC

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