title: Diagnosis and management for trigeminal neuralgia caused solely by venous compression.
abstract: Trigeminal neuralgia (TN) caused solely by venous compression is uncommon. An appropriate vein management protocol for microvascular decompression (MVD) has not been established. We evaluated the management of veins for TN solely due to venous involvement.
  
  
  
  We analyzed 31 patients with TN in whom only veins were manipulated during MVD. The culprit veins smaller in diameter than the vein of the cerebellopontine fissure (VCPF) were coagulated and divided in 20 patients (divided group), while transposition was performed for larger veins in the remaining 11 patients (non-divided group). Postoperative outcomes were assessed by Barrow Neurological Institute (BNI) pain intensity score and BNI facial numbness score.
  
  
  
  Preoperative contrast-enhanced T1 spoiled gradient recalled (SPGR) imaging exhibited higher detection rates for veins (93.5%) than non-contrast fast imaging employing a steady-state acquisition image (74.2%). The transverse pontine vein (TPV) was the most frequently involved vessel. All the divided veins were small TPVs except one. The non-divided group included seven cases of large TPVs and four involving the main trunk of the superior petrosal vein or its large tributaries. The median follow-up duration was 33 months. Pain relief was achieved immediately after the surgery in 28 (90.3%) and within a month in the remaining 3 (9.7%) patients. Numbness was present in seven (22.6%) patients at the final follow-up. Recurrence was observed in only two (10.0%) patients in the divided group compared with four (36.4%) patients in the non-divided group. Comparison at the final follow-up revealed that the divided group had superior outcome compared to the non-divided group.
  
  
  
  Contrast-enhanced T1 SPGR imaging is crucial to detect small veins in the preoperative diagnosis. Division of the culprit veins is recommended if the diameter is smaller than the VCPF as it provides a better outcome and lower recurrence rate than transposition.
authors.affiliation: Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan. takuro39@gmail.com.
authors.forename: Takuro
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Hirai
authors.affiliation: Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Shima
authors.affiliation: Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Suzuki
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Takanori
authors.initials: T
authors.lastname: Fukushima
authors.affiliation: Department of Neurosurgery, Subarukai Kotoh Kinen Hospital, 2-1 Hiramatsu-cho, Higashiohmi-shi, Shiga, 527-0134, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Matsuda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002550:Cerebral Veins / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology*; D008297:Male; D061145:Microvascular Decompression Surgery / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D014277:Trigeminal Neuralgia / Q000175:diagnosis / Q000601:surgery*
keywords: Diagnosis; Management; Microvascular decompression; Trigeminal neuralgia; Vein