Early Outcomes in Trigeminal Neuralgia After Microvascular Decompression and Percutaneous Rhizotomy: A Retrospective Cohort

Introduction: Microvascular Decompression (MVD) and Percutaneous Radiofrequency Rhizotomy (RPR) are key treatments for primary treatment-resistant Trigeminal Neuralgia (TN). Limited comparative data exist in Latin America regarding outcomes between open and percutaneous approaches. This study assesses early outcomes of TN patients undergoing MVD and RPR in a Colombian cohort, contributing insights to the regional understanding of TN management.

Methods: A retrospective cohort study was conducted from January 2015 to September 2024 at two hospitals, including adult patients with primary TN who received MVD or RPR as their first surgical treatment. The study assessed outcomes from preoperative evaluation to discharge. Data on demographics, affected nerve roots, laterality, vascular conflict imaging, procedure type, reintervention rates, and complications were collected. Pain intensity (BNI) and pain medication usage were primary outcomes. Statistical analysis was performed with a significance level of p < 0.05.

Results: Fifty-six patients were included (35 MVD, 21 RPR). No significant differences in age, affected side, or V2 involvement were found between groups. Preoperative pain was higher in the RPR group (p=0.03), and vascular conflict on imaging was more common in MVD cases (p=0.01). Postoperative pain was lower in MVD group, but not statistically significant (p=0.07). The MVD group required fewer postoperative analgesics (p=0.04). BNI of I was achieved in 31% of MVD and 24% of RPR cases (p=0.2). Reintervention rates were higher in RPR cases (33% vs. 17%, p=0.09). Complication rates were low and similar across groups (p=0.3).

Conclusion : MVD and RPR are both effective, safe options for primary TN, each showing significant postoperative pain reduction. The MVD group had a greater reduction in pain medication use, better pain control, and a lesser reintervention rate. Further prospective studies with longer follow-up are recommended to further distinguish outcome differences.