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S106: HYPERTENSION AND DIABETES ARE SIGNIFICANTLY ASSOCIATED WITH INCREASED RISK OF PAIN RECURRENCE FOLLOWING MICROVASCULAR DECOMPRESSION SURGERY FOR SINGLE-VESSEL COMPRESSION OF THE TRIGEMINAL NERVE
Ajay Pathakamuri, BS; Adway Gopakumar, BS; Shovan Bhatia, BS; Dongwon Lee, BS; Poliana Hartung Toppa, BS; William McKay, BS; Paul A Garder, MD; Georgios A Zenonos, MD; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

Introduction: Classical trigeminal neuralgia is due to direct vascular compression at the trigeminal nerve root entry zone, leading to paroxysmal and/or constant facial pain. Microvascular decompression (MVD) can provide effective pain relief; however, outcomes may vary based on the nature of the compression. Patients with multi-vessel compression (MVC) may represent a distinct population with different surgical challenges and prognoses compared to those with single-vessel compression (SVC). The purpose of this study is to explore predictors of pain relief following MVD stratified by single- and multi-vessel compression. 

Methods: A retrospective analysis of patients with TN undergoing MVD at a single institution from 2023-2025 was conducted. Demographics and TN characteristics at presentation were collected along with operative and follow-up data. The primary outcomes were long-term (at last follow-up) pain relief. Univariate and multivariable Cox proportional hazards regression and Kaplan-Meier survival analyses assessed prognostic factors for long-term pain relief for patients with SVC and MVC.  

Results: A total of 92 patients underwent 105 MVDs for TN. Of these, 67 (73%) had single-vessel compression, 84 (91%) presented with purely paroxysmal subtype, and eight (9%) patients reported pre-operative numbness. There was no significant difference between patients with single- or multi-vessel compression on long-term pain recurrence. Within patients with SVC, multivariate analysis showed that hypertension (HR: 3.73; 95% CI: [1.23-11.3]; p=0.02) and diabetes mellitus (HR: 7.45; 95% CI: [2.39-23.2]; p<0.01) were associated with significantly increased risk of long-term pain recurrence following MVD. In Kaplan-Meier survival analysis, patients with SVC and hypertension had a median pain relief duration of 5 years, compared to 9.4 years for those without hypertension. Patients with SVC and diabetes mellitus had a median pain relief duration of 2.1 years compared to 7.6 years for those without diabetes mellitus. 

Conclusion: Patients with single-vessel compression in classical TN undergoing MVD who have comorbidities of hypertension or diabetes mellitus have a significantly higher risk of pain recurrence at last follow-up.

Table 1. Cox proportional hazards regression for long-term pain recurrence following MVD for patients with single-vessel compression.

		Univariate			Multivariable
Co-morbidities in single-vessel compression (n=76)	HR	95% CI	p-value	HR	95% CI	p-value
High BMI (≥35)	2.33	0.83-6.55	0.11
Hypertension	3.73	1.23-11.3	0.02*	3.44	1.13-10.5	0.03*
Depression	1.25	0.40-3.87	0.71
Cardiovascular disease	1.40	0.45-4.33	0.56
Diabetes Mellitus	7.45	2.39-23.2	<0.01*	6.93	2.13-22.6	<0.01*

 

 

Figure 1. Kaplan-Meier survival curves of long-term pain relief stratified by A) single-vessel (SVC) and multi-vessel compression. Subgroup analysis was conducted on B) SVC and diabetes mellitus and C) SVC and hypertension.  

 

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