The Changing Face of Trigeminal Neuralgia

A Narrative Review

Stine Maarbjerg MD, PhD; Rafael Benoliel BDS (Hons)


Headache. 2021;61(6):817-837. 

In This Article

Microvascular Decompression

The procedure essentially separates between the intracerebral arteries and the trigeminal nerve root preventing pulsatile injury leading to chronic demyelination and subsequently TN. The relatively high surgical morbidity (10%) reported in 1996 declined to about 0.3%–3% in 2003, making MVD a safer option, but mortality remains a risk.[116] Complication rates are lowest in high-volume hospitals and when the surgeon performs a large number of MVDs yearly.[116] Pooled analysis supports the reliability of MVD, with 62%–89% of CTN patients pain free at 3–11 years.[57] In the long term, MVD seems the most cost-effective surgical approach to CTN.[202–204] A literature review on surgical modalities for CTN concludes that MVD is associated with the lowest rate of pain recurrence and the highest rate of patient satisfaction.[205] Patient satisfaction with MVD is particularly high when performed as a first intervention for CTN.[206] There is currently no clear evidence or recommendation to perform surgery early.[57,88,157] Some studies would indicate that early MVD surgery carries advantages, and patient satisfaction with neurosurgery is higher than that with pharmacotherapy.[189,207,208]