Microvascular Decompression for Trigeminal Neuralgia Using Autologous Muscle Grafting: A Retrospective Analysis in a Resource-Limited Setting.

Background Trigeminal neuralgia (TN) is a rare and painful condition that offers various treatment options. Despite the availability of multiple modalities, their comparative efficacy is still debated due to inconsistent study outcomes. Microvascular decompression (MVD) using autologous muscle grafts has recently gained attention as a treatment option. While muscle grafts were previously employed extensively, this approach is only now being introduced in Yemen, where documented outcomes related to MVD for TN are scarce. This study aims to present the outcomes of MVD for TN utilizing autologous muscle grafts in a resource-limited environment. Patients and methods This study employs a retrospective cross-sectional design involving 324 patients diagnosed with TN who underwent MVD using autologous muscle grafts between April 1, 2006, and March 25, 2020. Data regarding demographic and clinical factors, outcomes, and complications were systematically collected and analyzed. Results The mean age of the patients was 48.8±11.6 years, with the majority being female patients (n=180, 55.6%), with a significant proportion of patients exhibiting left-sided involvement (n=204; 63%). Significant nerve compression was the primary operative finding in the study population (n=251; 77.5%). In most cases, a single vessel contributed to the compression of the nerve, primarily the superior cerebellar artery (n=303; 93.5%). No major surgical complications were reported, with temporary nasal cerebrospinal fluid (CSF) leakage (n=1; 0.3%), transient facial numbness (n=16; 4.9%) that resolved within one week to one month, hyperacusis (n=5; 1.5%), and hyperesthesia (n=3; 0.9%) being the common ones. Follow-up over an average of 52.7±8.0 months indicated that the majority of patients (n=302; 93.2%) achieved favorable outcomes, as reflected in Barrow Neurological Institute (BNI) scores I and II. The BNI pain intensity score improved from V preoperatively to I and II and was statistically significant (P=0.006). The remaining patients (n=22; 6.8%) exhibited fair to poor BNI scores (III, IV, and V). Sixteen patients obtained effective pain relief through medication, while six required radiofrequency thermocoagulation. Conclusion  The findings suggest that MVD utilizing autologous muscle grafts may serve as an effective long-term surgical intervention for TN, even in resource-limited settings. Effective management of TN necessitates a comprehensive preoperative assessment, careful candidate selection, appropriate imaging techniques, and proficient surgical execution.