Evaluation of trigeminal nerve microvascular decompression with sensory root neurolysis

Libório dos Santos A.R.; Gonzales-Portillo M.; de Aguiar P.H.P. · Pain Management (2026) · DOI: 10.1080/17581869.2026.2648047

Resumen

Aims: To evaluate the outcomes of microvascular decompression combined with sensory root neurolysis in patients with medically refractory trigeminal neuralgia, including cases without radiological neurovascular compression. Patients and methods: This retrospective cohort study included 67 consecutive patients with medically refractory trigeminal neuralgia treated between August 2014 and June 2023. All patients underwent posterior fossa exploration with microvascular decompression and selective sensory root neurolysis under microscopy. Pain outcomes were assessed using the Barrow Neurological Institute (BNI) Pain Intensity Scale. Long-term follow-up data were analyzed. Results: In the early postoperative period, 89.5% of patients achieved complete pain relief (BNI I). At last follow-up (median 3.2 years), 82.1% maintained satisfactory pain control (BNI I-II). Pain recurrence occurred in 10.4% of patients. Immediate postoperative hypoesthesia was observed in 52.2%, with most cases improving over time. Persistent bothersome dysesthesia occurred in 4.5%. The overall complication rate was 6.0%, with no permanent disabling cranial nerve deficits. Conclusions: Microvascular decompression combined with sensory root neurolysis was associated with sustained pain relief and acceptable morbidity, including in selected patients without demonstrable neurovascular compression. This approach may be considered in carefully selected, medically refractory cases.