Microvascular Decompression in Trigeminal Neuralgia: Analysis of the Effectiveness of the Surgical Technique and Intraoperative Neuroanatomy-7 Years of Institutional Experience

Objective:  The study analyzed the effectiveness of microvascular decompression based on BNI score improvement and interpret the anatomy of offending vessels. Materials and Methods:  A total of 57 patients were included in the study. Data was collected and analyzed for age and gender distribution, the severity of pain, affected division of trigeminal nerve, duration of symptoms, type of petrosal vein, offending vessel, pre-op BNI score, one month & one-year post-op BNI score and major & minor complications of the procedure. Results:  The most common indication for patients to undergo microvascular decompression was side effects of pharmacological treatment, i.e., 36.8%.The most common combination of affected divisions involved was V1 & V2, i.e., 26.3%. BNI score was evaluated 24 hours after surgery and it was observed that 56 (98.2%) patients had a BNI Score of 1. After one year, 46 (80.7%) patients had a BNI Score of 1. So, an effective outcome of microvascular decompression was observed in 80.7% of patients. The most common offending vessel was arterial compression, i.e., 47 (82.4%). Among them, a superior cerebellar artery was found in 40 (85.1%) patients and an anterior inferior cerebellar artery in 7 (14.8%) patients. Conclusions:  Microvascular decompression is a safe and effective procedure for classical trigeminal neuralgia and arterial compression is found in the majority of patients. The BNI score is an effective tool for assessing and categorizing the patient's pre and postoperatively. Keywords:  Trigeminal neuralgia (TGN), Microvascular decompression (MVD), Barrow Neurological Institute (BNI) pain score, Cerebellopontine (CP) angle