(SS#III) Post-operative Outcomes Associated with Intra-operative Venous Transposition versus Coagulation in Trigeminal Neuralgia of Pure Venous Compression

Introduction: Microvascular decompressions (MVDs) are effective open-surgical procedures for trigeminal neuralgia (TN). For TN caused by venous compression, intra-operative management may include either venous transposition with Teflon pledgets or coagulation and subsequent division. Though both are generally considered safe, it is not clear which technique results in optimal post-operative outcomes. We sought to compare post-operative pain and numbness outcomes following an MVD in patients with TN of exclusive venous compression.

Methods: We retrospectively reviewed all patients with TN who underwent MVDs at our institution from 2007-2020. Patients with TN of pure venous compression were identified using MRI imaging, which was subsequently confirmed intra-operatively. Patient demographics, procedural characteristics, and post-operative Barrow Neurological Institute (BNI) pain and numbness scores were recorded and compared. Factors associated with pain recurrence were assessed using survival analyses and multivariate regressions.

Results: We identified 181 patients who underwent MVD for TN of pure venous compression. Venous transposition was performed in 59.7% of cases, and venous coagulation was performed in 40.3% of cases. Overall pain scores at final follow-up were found to be significantly decreased relative to pre-operative levels for both groups. Using a multivariate linear regression adjusted for age, sex, and presence of multiple sclerosis, use of venous transposition versus coagulation was not significantly associated with the BNI pain score at final follow-up, though venous transposition was significantly predictive of a worse post-operative BNI numbness score (p=0.003). Using a Kaplan-Meier survival analysis and a multivariate Cox proportional hazards regression, respectively, venous transposition was significantly associated with faster (p=0.01) as well as higher risk for pain recurrence (p=0.01).

Conclusion : The use of venous coagulation during an MVD is associated with better post-operative pain and numbness outcomes. The results of our study may help inform pre-operative patient counseling and surgical management for TN cases that involve pure venous compression.