Predictors of Postoperative Complications After Microvascular Decompression for Trigeminal Neuralgia and Hemifacial Spasm: A Retrospective Cohort Study.

BACKGROUND

Microvascular decompression (MVD) is a definitive treatment for trigeminal neuralgia and hemifacial spasm, but a subset of patients experiences postoperative complications. Identifying risk factors for these complications could improve perioperative management and patient counseling.

METHODS

We retrospectively analyzed 453 patients who underwent MVD for classic trigeminal neuralgia or hemifacial spasm from January 2020 to March 2024 at the First Affiliated Hospital of Anhui Medical University. Univariate analyses compared patients with versus without complications. Multivariate logistic regression was performed to identify independent predictors. Model performance was assessed with bootstrapped internal validation (1000 resamples), concordance index (C-index/area under ROC curve), and calibration analysis. A nomogram was constructed based on the final model.

RESULTS

In multivariate logistic analysis, elevated preoperative glucose (adjusted OR = 2.63 per 1 mmol/L increase, 95% CI: 1.96-3.66, P<0.001) and lower albumin (OR = 0.61 per 1 g/L, 95% CI: 0.51-0.71, P<0.001) emerged as strong independent predictors of complications. Incision type was not significant after adjustment (OR = 1.12, P=0.913), suggesting its crude effect was confounded by glucose and albumin. The final model showed excellent discrimination (bootstrap-corrected C-index = 0.904) and good calibration (calibration slope ≈ 0.97, intercept -0.05).

CONCLUSIONS

In patients undergoing MVD for trigeminal neuralgia or hemifacial spasm, elevated preoperative blood glucose and low serum albumin are significant predictors of postoperative complications. Future studies should validate this model externally and explore interventions (strict glucose management and nutritional support) to reduce complications in this patient population.