NESPS - Surgical outcomes following distal nerve decompression in patients with Trigeminal Neuralgia

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Surgical outcomes following distal nerve decompression in patients with Trigeminal Neuralgia
Katya Remy^*^¹, Merel H. Hazewinkel^², Leonard G. Knoedler^¹, Sierra Tseng^¹, William G. Austen^¹, Lisa Gfrerer^²
^¹Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA; ^²Plastic and Reconstructive Surgery, Well Cornell Medicine, New York, NY

Background
Patients with headache disorders may present with compression of distal trigeminal nerve branches as well as other head and neck nerve branches such as the occipital nerves. In addition to these distal compression neuralgias, a coexisting diagnosis of trigeminal neuralgia of proximal origin may be present. This overlap in diagnoses complicates treatment. Therefore, this study aims to investigate the therapeutic effects of distal nerve decompression surgery in patients with coexisting trigeminal neuralgia from a proximal origin.
Methods
The charts of 1,112 patients who underwent screening for nerve decompression surgery were retrospectively reviewed. Patients with trigeminal neuralgia who underwent nerve decompression surgery were included. Data regarding preoperative and postoperative pain characteristics were collected.
Results
17 (1.5%) patients met the inclusion criteria and underwent occipital decompression (n=15, 56%) (n=13 GON decompression, n=10 LON decompression), frontal decompression (n=5, 19%) (SON/STN decompression) and temporal decompression (n=6, 22%) (n=4 ZTN decompression, n=2 ATN decompression). The average time of postoperative follow-up was 17 (±12) months. Among the patients that underwent occipital decompression, 11 (73%) patients reported ≥80% pain relief, 1 (6.7%) patient reported ≥50% pain relief and 3 (20%) patients reported ≤20% pain relief. For frontal and or temporal decompression, only 2 (28%) patients achieved substantial pain relief (100% and 50%) while 5 (71%) patients experienced ≤20% pain relief.
Conclusions
Our results demonstrate that occipital nerve decompression is an effective treatment for alleviating occipital neuralgia in individuals with coexisting proximal trigeminal neuralgia. However, the outcomes of frontal and temporal decompression were less favorable.
Table 1. Postoperative pain characteristics

Variable	Occipital (n=15)	Frontal/temporal (n=7)
Decrease of pain frequency, days per month	6 (0-24)	0 (0-3)
Decrease of pain duration, hours	16 (0-22)	0 (0-9)
Decrease of pain intensity, 0-10	4 (2-7)	0 (0-1.5)

IQR, interquartile range

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