Microvascular Decompression for Trigeminal Neuralgia: Efficacy and Safety.

Background: Trigeminal neuralgia is a disabling facial pain disorder that can become refractory to medical treatment. Microvascular decompression provides direct relief of neurovascular compression and may achieve durable pain control. Evaluating postoperative pain relief and complications is important for assessing its efficacy, safety, and clinical applicability in appropriately selected patients undergoing surgical treatment. Objective: To assess the efficacy and safety of microvascular decompression (MVD) in patients with trigeminal neuralgia. Methodology: This prospective cohort study included 40 adults with medically refractory trigeminal neuralgia treated at Hayatabad Medical Complex, Peshawar, from March 2024 to March 2025. All patients underwent microscopic MVD. Postoperative pain was assessed using the Visual Analog Scale, while complications were evaluated at 4-week follow-up. Results: The mean age was 43.45 ± 14.82 years, and 62.5% were male. The maxillary division (V2) was most frequently involved. Complete postoperative pain relief was achieved in 35 (87.5%) patients. Mild and moderate residual pain occurred in 7.5% and 5.0%, respectively. Nausea was the most frequent complication (25%), followed by diplopia (7.5%), CSF leak (5%), and facial palsy (2.5%). Conclusion: Microvascular decompression provided substantial short-term pain relief with predominantly minor postoperative complications in patients with medically refractory trigeminal neuralgia.