Neurosurgery 96:667–672, 2025
• Tobacco use affects trigeminal neuralgia (TN) outcomes: Smokers with TN tend to develop symptoms at a younger age and have worse long-term outcomes after microvascular decompression (MVD) surgery compared to nonsmokers.
• Smokers show more widespread facial pain: TN in smokers is associated with a more widespread distribution of facial pain, suggesting a more severe form of the disease.
• Immediate postoperative outcomes similar: There is no significant difference in immediate postoperative outcomes between smokers and nonsmokers, although smokers are less likely to be pain-free in the long term.
• Potential benefits of smoking cessation: Patients with a remote history of smoking have outcomes similar to those who never smoked, indicating potential benefits of quitting smoking before surgery.
• Study limitations: The study is a single-center retrospective analysis and may not be generalizable to all TN patients or those undergoing different treatments.
• Implications for treatment: Findings suggest the need for presurgical counseling and support for smoking cessation to improve outcomes for TN patients undergoing MVD.
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