2026 Poster Presentations
P483: PROGNOSTIC IMPACT OF PAIN DISTRIBUTION IN TRIGEMINAL NEURALGIA ON LONG-TERM OUTCOMES FOLLOWING MICROVASCULAR DECOMPRESSION
William H McKay, MS; Adway Gopakumar, BS; Shovan Bhatia, BS; Poliana Hartung, BS; Dongwon Lee, BS; Ajay Pathakamuri, BS; Paul Gardner, MD; Georgios A Zenonos, MD; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
Introduction: Microvascular decompression (MVD) can relieve pain for patients with medically refractory trigeminal neuralgia (TN) and those with neurovascular compression. Importantly, pain distribution in TN is heterogeneous, most frequently involving the maxillary (V2) and mandibular (V3) division. Many patients experience multi-divisional TN, with isolated single-division pain occurring less frequently. These data suggest that multi-divisional TN represents a substantial subset of patients and may carry distinct clinical implications. Despite this, the predictors that may determine success following MVD for multi-divisional pain remains unclear. The aim of this study is to evaluate the pre-operative factors that may predict MVD outcomes of multi-division compared with single-division involvement.
Methods: A retrospective analysis of MVD for patients with TN from 2023-2025 at a single institution was conducted. Demographics at presentation and operative data were collected as well as post-operative outcomes using the Barrow Neurological Institute pain intensity score. The primary outcomes were short-term (at first-follow-up) and long-term (at last-follow-up) pain relief. Univariate and multivariable Cox proportional hazards models and Kaplan–Meier survival analyses assessed whether multi-division pain was a prognostic factor for pain outcomes.
Results: Among the 152 patients undergoing 157 MVD procedures, all with confirmed neurovascular compression (NVC), 122 (77.7%) had multi-division TN and 35 (22.3%) had single-division TN. Paroxysmal pain was the baseline pain subtype for 103 (84.4%) multi-division TN patients and 32 (91.4%) single-division TN patients. Concomitant continuous/dull pain was the baseline subtype for 19 (15.6%) multi-division TN patients and 3 (8.6%) single-division TN patients. Preoperative numbness was present for 8 (6.6%) multi-division TN patients and 3 (8.6%) single-division TN patients. Short-term pain relief was achieved in 31 (88.6%) patients with single-division TN and 115 (94.3%) with multi-division TN. Long-term pain relief was achieved in 24 (66.7%) single-division and 98 (80.3%) multi-division patients. The median duration of long-term-pain-relief was 91.07 months for multi-division TN patients and 54.1 months for single-division TN patients. On univariate analyses for long-term-pain-relief, patients with multi-division TN at presentation (HR: 0.453; 95% CI: [0.0.224-0.917]; p=0.028) were associated with improved outcome. The median duration of long-term-pain-relief in multi-division TN was 67.2 months for patients with diabetes mellitus at presentation and 91.07 months for patients without diabetes mellitus at presentation. On univariate analyses for long-term-pain-relief in multi-division TN, patients with diabetes mellitus at presentation (HR: 3.375; 95% CI: [1.215-5.145]; p=0.02) were associated with worse outcome.
Conclusion: Multi-division pain was associated with improved long-term pain relief following MVD in patients with TN. Diabetes mellitus at presentation was associated with worsened long-term pain relief following MVD in patients with multi-division TN.
Figures
Figure 1. Probability of Long-Term Pain Relief Following MVD in Patients with Single-division TN vs Multi-division TN (p=0.028)
Figure 2. Probability of Long-Term Pain Relief in Multi-division TN Following MVD in Patients With vs Without Diabetes Mellitus at presentation (p=0.02)