Outcomes of microvascular decompression for trigeminal neuralgia with purely venous compression: A systematic review and meta-analysis

Objective: Microvascular decompression (MVD) is a commonly-used treatment option for medically-refractory trigeminal neuralgia (TN) with arterial neurovascular compression. Pain control and recurrence rates after MVD in patients with purely venous compression are not well understood. In this systematic review and meta-analysis, we studied outcomes after MVD in patients with purely venous compression and reviewed the operative management in these patients. Methods: We performed a systematic review and meta-analysis following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. We searched PubMed, Google Scholar, and Scopus databases for studies reporting surgical outcomes after MVD for purely venous compression. Pain control and recurrence rates were extracted and summarized. Studies that reported outcomes after mobilization/decompression compared with coagulation/transection of compressive veins were reviewed. Results: We identified and included 24 studies with a total of 330 patients in this study. 75.6 % of patients achieved a Barrow Neurological Institute (BNI) I pain score with a mean follow-up of 38.0 months. Pain recurred in 23.1 % of patients at a mean follow-up of 51.4 months. There was no significant difference in pain control outcomes between patients with mobilization/decompression and patients with coagulation/transection of compressive veins. Conclusion: After MVD in patients with venous compression alone, pain control rates were similar to those reported for arterial compression, though recurrence rates were higher. There was no difference between vein coagulation/transection compared to mobilization/decompression. Further studies are needed to determine the optimal treatment paradigm for patients with purely venous compression.