Abstract
BACKGROUND: Trigeminal neuralgia secondary to vertebrobasilar dolichoectasia (VBD-TN) poses a significant challenge in the surgical management of trigeminal neuralgia. This study aimed to evaluate and compare the therapeutic efficacy of microvascular decompression (MVD) and percutaneous balloon compression (PBC) in patients with VBD-TN. METHODS: We conducted a retrospective cohort analysis of consecutive VBD-TN patients treated at a tertiary hospital in China between September 2013 and August 2022. Participants were stratified by the intervention (MVD vs PBC), with systematic evaluation of postoperative pain control efficacy and complication rates. RESULTS: This study enrolled 107 patients with VBD-TN, with a mean age of 64.8 ± 10.0 years and a mean follow-up duration of 3.9 ± 1.9 years. The cohort comprised 64 patients undergoing MVD and 43 receiving PBC. Both groups achieved excellent initial pain control (The Barrow Neurological Institute scoring system (BNI) pain score I or II). The recurrence (BNI Ⅲ, Ⅳ, Ⅴ) rates were 12.5% (8/64) in the MVD group versus 20.9% (9/43) in the PBC group (p = 0.242) at the last follow-up, showing no statistically significant difference. Early postoperative assessment revealed significantly higher incidences of trigeminal dysfunction including facial numbness, dry eye symptoms, and masticatory muscle weakness in the PBC group compared to the MVD group (p < 0.05 for all). Conversely, the MVD group demonstrated more diverse complications, with craniotomy-related adverse events including intracranial infection (4.7%), cerebrospinal fluid leakage (3.1%), and incision infection (3.1%), while cranial nerve complications comprised diplopia (3.1%), facial palsy (1.6%), hearing loss (7.8%), and tinnitus (9.4%). At the final follow-up, the PBC group exhibited significantly higher BNI numbness scores than the MVD group (p = 0.001). The PBC group showed advantages in healthcare utilization metrics, with significantly shorter postoperative hospital stays and lower hospitalization costs compared to the MVD group (p < 0.001). CONCLUSIONS: Both MVD and PBC are safe and effective therapeutic options for VBD-TN. MVD is associated with higher hospitalization costs, prolonged hospital stays, and a greater incidence of cranial nerve complications, though most of these complications are treatable. The main disadvantage of PBC lies in the long-term facial numbness.