Surgical treatment for idiopathic trigeminal neuralgia caused by venous compression: analysis of 33 cases

Objective To explore the operative features and results of idiopathic trigeminal neuralgia (TN) caused by venous compression. Methods Surgical management technique and outcomes in 33 TN patients were retrospectively analyzed. Compressing venules were electrically coagulated and blocked, and the offending branches of superior petrosal vein complex (SPVC) were partially blocked with the vein trunk preserved. After the veins were divided away from the compressed nerve and the entire cisternal trigeminal nerve were exposed, Teflon graft was properly interpositioned to encircle the whole range of it. Results Location of the vein compression can be at all along the cistemal trigeminal nerve. In the 33 TN patients, 22 were attributed to vein compression associated with artery offence, and 11 to simple vein conflict venous compression, among them 3 to anonymous veins and 8 to SPVC near Meckel's cave. The drainage patterns of the SPVC were classified into 3 groups. The pain get completely relieved in all patients after microvascular decompression(MVD). No recurrence was found during the follow-ups of 2.5 years on average. Four patients developed trigeminal nerve impairment and 2 suffered from disordered cerebellum function after operation, but these complications were all improved through treatment. Conclusions SPVC is the most common offensive vein.Whether the venous compression is main compressing factor or not, it was essential to deal with them properly to get the trigeminal nerve completely decompressed from veins. MVD can accurately identify the venous compression and reduce the recurrence, however, it may result in higher postoperative complications. Key words: Surgical treatment; Microvascular decompression; Trigeminal neuralgia; Venous compression