J Neurosurg 143:970–981, 2025
This study compared interposition and “contactless” transposition (Teflon and pericranial sling) microvascular decompression techniques for trigeminal neuralgia. Both were effective, but sling transposition showed improved midterm pain control and fewer complications. The only significant predictor of pain freedom was MRI evidence of clear nerve compression.
• Microvascular decompression (MVD) is a main surgical treatment for trigeminal neuralgia (TN), traditionally using Teflon interposition between nerve and artery.
• Recurrence of TN pain after MVD is often due to Teflon complications, prompting the development of “contactless” transposition techniques such as Teflon and pericranial sling transpositions.
• This retrospective study compared outcomes of interposition, Teflon transposition, and pericranial sling transposition in 305 TN patients.
• Sling transposition was mainly used for severe compression by the superior cerebellar artery and involved securing the artery to the tentorium with a pericranial graft.
• All techniques had similar short-term pain relief and complication rates, but sling transposition showed significantly higher pain-free rates at 2 years compared to other methods.
• Clear vascular compression on MRI was the only significant predictor of pain freedom in multivariate analysis.
• Sling transposition uses autologous tissue, avoids foreign body reactions, and may provide more durable pain control, but is technically more complex.
• Further long-term studies are needed to confirm the durability of sling transposition for TN pain control.
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