• Toshiki Fukuoka, Yusuke Nishimura, Masahito Hara, Kei Nomura, Hiroshi Ryu, Satoshi Yoshikawa, and Toshihiko Wakabayashi.
• Department of Neurosurgery, Nagoya University, Graduate School of Medicine, Nagoya, Japan.
• World Neurosurg. 2018 Mar 1; 111: e519-e526.

ObjectiveTo investigate the prognostic factors for microvascular decompression (MVD) in patients with primary trigeminal neuralgia (TN), with a particular focus on the morphology of the posterior cranial fossa (PCF).MethodsThe present study investigated 126 surgically treated patients with primary TN with more than 1-year follow-up who underwent high-resolution magnetic resonance imaging between April 2003 and September 2015. We retrospectively reviewed clinical information and operative findings. Outcomes of MVD were also evaluated and patients were classified into "success" and "failure" groups. Furthermore, length, width, and height of the PCF were measured by approximation to an ellipsoid with reference to the anterior commissure-posterior commissure line. These values were compared between groups.ResultsAtypical type 2 TN (P < 0.001) and weak neurovascular compression (P < 0.001) correlated significantly with poor outcomes of MVD for primary TN. In terms of PCF morphology, the failure group showed a flatter PCF than the success group, whereas sex, age, affected side, topography of facial pain, interval between onset and surgery, responsible vessel, location of compression along the nerve, and site of compression around the circumference of the nerve root did not significantly affect outcomes of MVD for primary TN.ConclusionsThe present study identified type 2 TN, weak neurovascular compression, and flatness of the PCF as predictors of poor prognosis after MVD for primary TN.Copyright © 2017 Elsevier Inc. All rights reserved.

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