• World Neurosurg · May 2023

    Sex-specific pain outcomes following microvascular decompression for trigeminal neuralgia.

    • Collin B Kilgore, Raymond J So, Kaitlyn Storm, Sumil K Nair, Kathleen R Ran, Anita L Kalluri, Michael Lim, Judy Huang, Chetan Bettegowda, and Risheng Xu.
    • Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
    • World Neurosurg. 2023 May 1; 173: e431e435e431-e435.

    BackgroundTrigeminal neuralgia (TN) is more prevalent among women. However, while microvascular decompression (MVD) is the most effective long-term surgical treatment for TN, it is unclear whether it is equally efficacious for men and women. We sought to characterize the relationship between sex and pain outcomes following MVD for TN.MethodsFrom 2007 to 2020, 938 unilateral TN patients were treated with MVD at our institution. Patient demographics, clinical characteristics, operative features, and pain outcomes were recorded. Differences between men and women were analyzed via t-test and chi-squared analyses. A multivariate ordinal regression was used to establish significant predictors of pain outcome. Differences in time to pain recurrence were assessed via Cox proportional hazards and Kaplan-Meier nonparametric survival analysis.ResultsA majority (67%) of the 938 patients analyzed were female. Men and women presented with similar preoperative pain severity (P = 0.17). Female sex (P = 0.048) and younger age (P = 0.03) were independently associated with worsened Barrow Neurological Institute pain scores at 3-month follow-up on multivariate analysis. Women were also more likely to experience recurrence than men (P = 0.01), and time to recurrence was shorter among women (P = 0.02). Only female sex was independently associated with increased risk of postoperative pain recurrence on multivariate Cox proportional hazards regression (P = 0.01).ConclusionsFemale TN patients undergoing MVD had worse pain outcomes, more frequent pain recurrence, and shorter time to recurrence. Our results indicate a sex-specific dimorphism in response to MVD among TN patients.Copyright © 2023 Elsevier Inc. All rights reserved.

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