Prognostic impact of multi-divisional trigeminal neuralgia on pain outcomes following microvascular decompression

Clin Neurol Neurosurg. 2026 Jun 15;269:109543. doi: 10.1016/j.clineuro.2026.109543. Online ahead of print.

ABSTRACT

OBJECTIVE: Microvascular decompression (MVD) is the gold standard surgical treatment for medically refractory trigeminal neuralgia (TN). Pain distribution in TN is heterogeneous, with multi-divisional involvement representing a substantial patient subset; however, whether division pattern predicts MVD outcomes remains unclear. The aim of this study is to evaluate preoperative factors that predict MVD outcomes in patients with multi- versus single-divisional trigeminal involvement.

METHODS: A retrospective analysis of MVD for TN from 2016 to 2025 at a single quaternary institution was conducted. Demographics, operative data, and postoperative outcomes were collected using the Barrow Neurological Institute (BNI) pain intensity score. Univariate and multivariable Cox proportional hazards models and Kaplan--Meier survival analyses assessed whether multi-divisional pain was a prognostic factor for pain outcomes.

RESULTS: A total of 328 patients undergoing 339 MVDs were included; multi-divisional pain was present in 252 (76.6%) of 329 classifiable procedures. There was no difference in immediate (p = 0.71) or pain outcomes at last follow-up (p = 0.78) between groups. Overall, age, concomitant continuous pain, and interposition technique were associated with increased risk of inadequate pain relief at last follow-up. In single-divisional TN, concomitant continuous pain, baseline number of medications, prior gabapentin use, prior baclofen use, and interposition technique each predicted failure on univariate analysis. In multi-divisional TN, older age (HR: 1.01; 95% CI: [1.00--1.03]; p = 0.002) independently predicted failure on multivariable analysis.

CONCLUSION: Single- and multi-divisional TN present with similar overall surgical outcomes. Division-specific associations with inadequate pain relief at last follow-up were identified but were exploratory, and warrant validation in larger prospective cohorts. These findings may help refine patient counseling and treatment planning for TN.

PMID:42314543 | DOI:10.1016/j.clineuro.2026.109543