Evaluating Surgical Outcomes of Microvascular Decompression With and Without Nervus Intermedius Sectioning for Geniculate Neuralgia: A Single-Institution Study

Introduction: Geniculate Neuralgia (GN) is a severe, recurrent facial pain caused by compression of the nervus intermedius (NI) branch of the facial nerve. The standard surgical intervention for medically refractory patients is microvascular decompression (MVD) via retrosigmoid craniotomy. Despite surgical advancements, few studies assess post-surgical GN outcomes across diverse settings.

Methods: We conducted a retrospective review of patients surgically treated between June 2013 and February 2024 as an expansion of our institution's previously described dataset for GN treatment. Data included demographics, concurrent cranial neuralgias, vessel compression on CN V, extent of arachnoid adhesion release around CN 7/8, NI sectioning status, and post-operative complications. Pain intensity was measured using the Barrow Neurological Institute (BNI) pain scale pre- and post-operatively. Descriptive statistics summarized patient characteristics, and a paired t-test assessed changes in BNI scores.

Results: We analyzed 54 patients (88.9% female, mean age 46.6 ± 12.8 years). Preoperatively, 96.3% had severe pain (BNI IV-V). Postoperatively, 68.5% achieved complete pain relief (BNI I), and 7.4% had moderate reduction (BNI II-III). Mean pain reduction (DiffBNI) was -3.08 ± 1.52 (p < 0.001). NI sectioning, performed in 75%, showed slightly greater pain reduction (-3.22) than non-sectioned cases (-2.55) but was not statistically significant (p = 0.15). Postoperative complications were rare: unexpected hearing loss (1.85%), facial paralysis (1.85%), and vestibular dysfunction (5.56%). NI sectioning did not significantly increase complication risk (p > 0.05). No outcome differences were noted based on laterality or prior GN surgery. Freeing dense arachnoid adhesions around CN 7/8 (15.1%) was not associated with improved outcomes.

Conclusion : Treatment of Geniculate Neuralgia provides significant pain relief for patients, with over two-thirds of patients achieving complete resolution of their symptoms. NI sectioning enhances surgical outcomes but lacks statistical significance. The procedure’s low complication rate supports its role as the preferred surgical treatment for refractory GN. Future research should assess long-term symptom durability and refine patient selection for optimal outcomes.