• Nicolas Almqvist Téran, Richard Loayza, Johan Wikström, Hans Ericson, Sami Abu Hamdeh, and Teodor Svedung Wettervik.
• Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
• World Neurosurg. 2023 Nov 1; 179: e397e403e397-e403.

ObjectiveA small posterior fossa (PF) has been hypothesized to explain the increased incidence of trigeminal neuralgia (TN) in females and could make microvascular decompression (MVD) more challenging. The aim of this study was to investigate the association between the PF volume and dimensions in relation to biological sex, type of neurovascular conflict (NVC), and outcome after MVD in classic TN.MethodsIn this observational study, 84 patients with TN operated on with MVD with a preoperative head computed tomography(CT) scan were included. Eighty-two adults without TN who had undergone head CT for other reasons were included as controls. PF volume and dimensions (x-axis, y-axis, and z-axis) were evaluated on the CT scans. For the patients with TN, Barrow Neurological Institute (BNI) grade was evaluated 6 months after MVD.ResultsThere was no difference in PF volume or dimensions between the patients with TN and controls. Women showed a smaller volume and narrower (x-axis) PF than men, but these differences did not manifest when comparing patients with TN and controls within each sex. Patients with an NVC involving the superior cerebellar artery had a narrower (x-axis) and shorter (y-axis) PF than did patients with an NVC resulting from other arteries. PF volume or dimensions were not associated with BNI grade after MVD.ConclusionsPF anatomy was related to the NVC type but did not differ between patients with TN and controls and was not related to the surgical outcome after MVD.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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