Comparative efficacy of microvascular decompression and radiofrequency rhizotomy in idiopathic trigeminal neuralgia with a neurovascular contact without root distortion.

OBJECTIVE

This study aimed to compare the long-term pain control outcomes between microvascular decompression (MVD) and radiofrequency rhizotomy (RFR) in patients with idiopathic trigeminal neuralgia (TN) with a neurovascular contact without root distortion after first-time surgical treatment, as there is no clear recommendation for choosing between these surgical modalities for this patient group.

METHODS

This retrospective study evaluated patients diagnosed with idiopathic TN with a neurovascular contact without root distortion. Patients treated with MVD or RFR as first-time surgical treatment were included.

RESULTS

A total of 26 patients were included, with 20 treated with MVD and 6 with RFR. Patients treated with MVD exhibited a longer median time until pain recurrence compared to those treated with RFR (median 24 months [CI 9.38-38.62] vs. 5 months [CI 0-11], p = 0.05). Further subanalysis revealed that these differences were primarily seen in a specific subgroup: patients in the MVD group with a preoperative symptom duration of <5 years (PSD < 5Y). This subgroup demonstrated a significantly lower risk of pain recurrence compared to those treated with RFR, with a Hazard ratio of 7.791 (95% CI 1.379-44.013; p = 0.02).

CONCLUSION

MVD resulted in superior pain control compared to RFR in patients with idiopathic TN with a neurovascular contact without root distortion and with a PSD < 5Y, after initial surgical treatment. However, caution should be exercised in interpreting these findings due to study limitations, including its retrospective design and small sample size. Further research is warranted to validate these results.