J Neurosurg 143:92–99, 2025
Prolonged preoperative conservative management with anticonvulsants in trigeminal neuralgia is associated with worse pain outcomes and higher pain recurrence after microvascular decompression. Early surgical intervention may improve postoperative results and reduce pain recurrence risk in these patients.
• Longer duration of preoperative conservative management (anticonvulsant use) before microvascular decompression (MVD) for trigeminal neuralgia (TN) is linked to worse postoperative pain outcomes and higher risk of pain recurrence.
• Median duration of conservative management before surgery was 1.74 years.
• Patients with longer conservative management had higher final BNI pain scores and greater rates of pain recurrence than those with shorter management.
• Longer conservative management predicted shorter pain-free survival after MVD.
• Younger age and longer conservative management duration were independent predictors of worse postoperative pain and recurrence.
• No significant difference in preoperative pain scores between groups; both had high pain levels pre-surgery.
• Findings suggest early surgical intervention may benefit TN patients who are candidates for MVD.
• Study was retrospective and single-institution, limiting generalizability; further research is needed.
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